SPRING 2006
psychologist A SS TT EE XX A
Diversity in Academic Settings TPA Distinguished Professional Contribution Awards Student Merit Research Awards
Intervening in Complicated Bereavement www.texaspsyc.org
Donna Davenport, PhD Brian Stagner, PhD Co-Editors
David White, CAE Executive Director
Sherry Reisman Director of Conventions
Lindell Brown Executive Assistant
Lynda Keen Bookkeeper
Amber Frausto
FEATURES
Administrative
Jane Harrington
10
Administrative
Randy Noblitt, PhD James R. Noblitt, BA
TPA Board of Trustees Melba Vasquez, PhD
Appreciating Diversity in Academic Settings
16
President
M. David Rudd, PhD
Intervening with Complicated Bereavement: Lessons from the Scott & White Grief Study Louis A. Gamino, PhD, ABPP
President-Elect
Kenneth W. Sewell, PhD
Ron Cohorn, PhD President-Elect Designate
22
Paul Burney, PhD Past President; CAPP Representative
Relational Psychotherapy Supervision: A Shared Supervision Story Roderick D. Hetzel, PhD and A. Sydney Kroll, MS
Board Members Tim Branaman, PhD, ABPP Mary Alice Conroy, PhD Donna Davenport, PhD Alan Fisher, PhD Robert McPherson, PhD Randy Noblitt, PhD Lane Ogden, PhD Verlis Setne, PhD Brian Stagner, PhD Thomas Van Hoose, PhD Alison Wilson, PhD
Ex-Officio Board Members Mimi Wright, PhD
28
David Weigle, PhD, MPH
DEPARTMENTS 4
Elizabeth Richeson, PhD
From the Editor Donna Davenport, PhD
6
From the President Melba J. T. Vasquez, PhD, ABPP
PSY-PAC President
Texas Psychology Foundation President
Psychologists, the Homeless, and HIV
8
From TPA Headquarters David White, CAE
Jerry Grammer, PhD Business of Practice Network Rep.
30
Student Merit Research Awards
Federal Advocacy Coordinators
31
TPA Distinguished Professional Contribution Awards
Ollie Seay, PhD Sherry Reisman
34
Legislative Champions TPF Contributors PSYPAC Contributors
34
Classified Advertising
Deborah Horn Student Division Director
The Texas Psychological Association Is located at 1005 Congress Avenue, Suite 410, Austin, Texas 78701. Texas Psychologist (ISSN 0749-3185) is the official publication of TPA and is published quarterly.
www.texaspsyc.org WINTER 2006
3
Texas Psychologist
FROM THE EDITOR
Donna Davenport, PhD
especially influenced by learning the extent of training a Child Psychologist with a Masters in Psychopharmacology has, but the Senate and NAMI might be quite interested. At least a partial solution is right in front of them, but apparently not being discussed at all. APA and others must find a way to contribute forcefully and immediately to this debate.
I
have been a bit ambivalent about the Prescription Privileges for Psychologists movement. Although I agreed theoretically that psychologists could without a doubt be trained well enough to prescribe psychotropic medications, it was not a direction I planned to personally pursue. Too much of that chemistry bullet I was pleased to have dodged when I opted not to go the medical route in the first place! Last week, on the heels of Senate testimony, the Associated Press released an article on the shortage of child psychiatrists that caught national attention. “In state after state, bleak statistics and grim anecdotes lead to the same diagnosis: America suffers from a serious, long-term shortage of child psychiatrists. . .Because
4
of the shortage, pediatricians, family doctors, and child psychologists have been filling the void, though their training is far less thorough [emphasis mine].” One of the remedies being considered is to shorten the five-year psychiatric residency requirement, or to allow students specializing in child psychiatry to begin working with students sooner in their training. What is not being discussed in this forum is the potential contribution of child psychologists who had earned prescription privileges. This issue is being being debated before the Senate, with primary input from AACAP (American Academy of Child and Adolescent Psychiatrists) and NAMI (National Alliance on Mental Illness). I somehow doubt that AACAP would be
“Child psychologists have been filling the void, though their training is far less thorough.” - From AP Release On a different note, reflecting other changes of note in Texas, I hope you’ll enjoy the articles in this month’s issue— Louis Gamino’s discussion of research on bereavement, Hetzel/Kroll contribution describing the application of the Cultural/ Relational Theory to supervision, and the Nobbits’ presentation of diversity issues in psychology and academia. SPRING 2006
CONFIDENTIAL AND EXPERIENCED
LEGAL REPRESENTATION FOR
TEXAS PHYSICIANS
Representation before The Texas State Board of Examiners of Psychologists, Texas Medical Board, The Texas Medical Foundation, and Medical Staff Peer Review. • Personal Counsel in Medical Liability Cases • Non-Profit Certification / Recertification • Probation Modification / Termination • Managed Care Exclusions • Licensure • Reinstatement • Medico-legal Issues • Expert Review • Telemedicine • Medical Ethics Opinions • Physician Assistants. MICHAEL SHARP*
COURTNEY NEWTON**
TONY COBOS**
SHARP & COBOS, P.C. ATTORNEYS AT LAW 4705 SPICEWOOD SPRINGS ROAD • SUITE 100• AUSTIN, TEXAS 78759 • 512 473 2265 • FAX: 512 473 8525 • www.sharpcobos.com * Board Certified in Administrative Law by the Texas Board of Legal Specialization. ** Not Board Certified by the Texas Board of Legal Specialization.
MARK YOUR CALENDARS TPA 2006 Annual Convention (Dallas) November 16-18, 2006 (online registration already available!) TPA Membership Dues Renewal Deadline December 31, 2006 National Multicultural Conference and Summit (Seattle) Januar y 24-26, 2007 TPA 2007 Annual Convention (San Antonio) November 15-17, 2007 TPA 2008 Annual Convention (Austin) November 20-22, 2008 SPRING 2006
DEATH NOTICE Dr. Robert J. Ginn, Clinical Psychologist for over 30 years, passed away on December 18, 2005. Dr. Ginn maintained his TPA membership for 35 years. His birthdate was October 30, 1935. He is survived by his loving wife, Norma and devoted family and in-laws. 5
Texas Psychologist
FROM THE PRESIDENT
T
he Executive Committee of the Texas Psychological Association (made up of the President, President-elect David Rudd, President-elect designate Ron Cohorn, Past President Paul Burney, Executive Director David White {ex-officio} and with consultation from Director of Professional Affairs Bob McPherson) has been very busy for the last few months. We have had several unexpected challenges. LAS Retreat. By the time you read this, an emergency retreat held with the Presidents of the Local Area Societies (LAS) will have occurred. The goals of the retreat included to develop Action Steps to implement at each Local Area Society in order to have a successful Legislative year in 2007. We are developing a comprehensive plan to identify legislators in key committees (e.g. Public Health, Health & Human Services, Government Reform), and to nurture relationships with them. Continue TPA Membership and Contribute to Psy-Pac. The 2005 legislative session was very important and successful for psychologists in Texas. The Texas Psychological Association and our Political Action Committee, PSY-PAC, worked tirelessly with legislators advocating for psychologists and important mental health issues. During this last legislative session the Sunset Review of our licensing board received a great deal of our attention. Much of the work concerned educating legislators regarding our issues and offering our Association as a resource. Unfortunately 6
Melba J. T. Vasquez, PhD, ABPP
this work is never finished, it is an ongoing process. Each year we are faced with new challenges that affect our scope of practice and provision of services. Many of us contribute numerous hours to provide service as well as financial contributions that result in benefit for all psychologists and consumers in Texas. It is vital that all Texas psychologists be members of TPA, and that we contribute financially, as well as participate in professional advocacy when possible. Licensed Psychological Associates initiative for independent practice. Recently the Texas Association of Psychological Associates (TAPA) suggested an interpretation that the Sunset Review changes now allow independent practice for individuals with a master’s degree. We are working hard to prevent the pressure by TAPA on our Texas State Board of Examiners of Psychologists to accept their proposed rule changes. TPA had representation at the last few TSBEP meetings in order to articulate the critical need to continue to recognize the doctorate as the minimum educational requirement for entry into professional practice as a psychologist. This is the same position taken by the American Psychological Association. LPAs who choose to practice independently can seek avenues of other licensed professions, such as licensed professional counselors, social workers, or licensed marriage and family therapists; these professions have demonstrated a commitment for increasing standards for graduate training, post degree supervised experience, and standardized professional
test performance for entry into their respective professions. In fact, that vast majority of LPAs do hold other licenses and certifications. Lowering the nationally embraced licensing standards for professional psychology does not strengthen the profession for the public. This struggle will likely continue at the legislative level, and we need your help in ensuring that our voices will be heard in that arena. Again, please donate generously to PSY-PAC, the only political action committee that speaks for psychologists. Licensed Specialists in School Psychology. In addition, the Licensed Specialists in School Psychology (LSSP), a master’s level credential, informally requested that their name be changed to School Psychologists. These issues were discussed with concern by the TPA Division of School Psychologists at our last convention, given that the title of “School Psychologist” requires a doctoral level credential. Recently, we were notified that the TÅSP has decided to withdraw the consideration for now. The analogies that have been proposed in response to the requests and proposals for both LPAs and LSSPs include that changes in title and scope of practice would be like: • A Dental Hygienist stating that they were a Dentist, • A Nurse Practitioner stating that they were a Medical Doctor, or • A Paralegal stating that they were a Lawyer. SPRING 2006
Texas Psychologist
Sex Offender Licensure. The Council on Sex Offender Treatment (CSOT) recently published rules implementing HB 2036, which changed the sex offender treatment certification into licensure. The rules would have prevented all mental health providers from treating a wide variety of sexual dysfunction concerns by people who have not committed crimes unless one was certified and licensed with this new requirement. TPA testified against adopting of rules; we essentially conveyed the fact that the new rules infringed on the ability of the general practitioner to treat people who often have sexual behavior as one of their many concerns. Fortunately, the CSOT determined not to adopt the proposed rules. We will remain vigilant to review the next set of rules, with the hope that licensure as psychologists is recognized as evidence of competency to provide treatment for non-criminal sexual behaviors.
in the column, “Psychology in the Public Interest” column, this issue. In addition, several leaders and volunteers of TPA attended the APA State Leadership Conference in Washington, DC in March. TPA Training Continuing Education Training Opportunities. Ethics in Psychopharmacology will be held in Frisco, Texas (near Dallas) on April 22. Lane Ogden, Cheryl Hall and Dee Yates will be providing the training, and psychologists are invited to an afternoon session that will focus on organization and strategy to achieving prescription privileges for properly trained psychologists. Register at www. texaspsyc.org. Come to Austin to attend the Professional Education Conference. On the afternoon of
May 5th, Former TSBEP Chairs David Rudd and Brian Stagner will provide a three hour workshop on resolving complaints against your license. On Saturday, May 6, a number of wonderful programs are offered by Dean Paret (CPT Codes and Practice Challenges), Attorney Sam Houston (Legal Pitfalls); Andrew Benjamin (Developing a Practice in Family Evaluation); and APA’s Geoffrey Reed (Evidenced-Based Practice). Lunch on Saturday will include a program provided by Judith Andrews, on TPA’s Disaster Response Network. Register at www. texaspsych.org. Plan to attend the TPA annual convention on November 16-18, 2006 at the Westin Galleria in Dallas, Texas! The Call for programs is also available on the website.
Underfunding of Mental Health Services in Texas. We are engaged in several advocacy efforts to encourage various entities such as the Department of State Health Services to fund a coordinated effort with the communities of Texas to address prevention, early intervention, and the continuing case management, medication, and vocational support needs of persons with mental illness and substance abuse disorders. We are seriously concerned about the underfunding of mental health services in Texas for those in need, especially those in crisis. A number of factors have resulted in catastrophic consequences, including the use of jails to handle individuals in crisis. Thanks to the special efforts of Ollie Seay and Bonny Gardner. Conference Representation. Several TPA officers and members attended the American Psychological Association Immigration Conference held in February in San Antonio, Texas. A very inspiring day of sessions helped psychologists better understand the complex issues and needs of immigrant populations. See the article on immigration SPRING 2006
7
Texas Psychologist
FROM TPA HEADQUARTERS
David White, CAE
Shortage of Mental Health Professionals
R
ecently TPA President, Melba Vasquez, PhD, and I attended a one-day conference hosted by the Hogg Foundation dealing with the status of the mental health care practitioners in Texas. The speakers at this conference focused on the supply of mental health professionals in Texas. According to a study conducted by the Health Professions Resource Center. Texas is facing a shortage of mental health providers. With Texas continuing to grow, it is no surprise that Texas’s rural areas are suffering the most from the lack of mental health services providers. The Social Workers are best represented in the rural areas with 45.1 Social Workers/100,000 population. But it was psychologists who had the largest representa-
Mental Health Professionals supply ratios* in Rural Areas Year
Social Workers LPC’s
Psychologists
MFT’s
LCDC’s
Psychiatrists
1999
54.7
30.9
9.8
6.2
21
2.9
2005
45.1
31
10.3
5.7
17.3
2.6
Mental Health Professionals supply ratios* in Texas Year Supply Social LPC’s Ratio Workers
Psychologists
MFT’s
LCDC’s
Psychiatrists
1999
73.9
48.4
24.8
16.1
22.3 (2002)
6.5
2005
68.2
47.4
24.2
12.1
18.2
5.6
Overall, the number of psychologists increased 14% since 1999, however, the supply ratio* has decreased from 24.8 in 1999 to 24.2 in 2005. This can be attrib-
Texas needs more appropriately trained mental health professionals who are capable to prescribe medications. tion increase in rural areas as they increased their presence by 5% over the last 6 years. This increase equates to 8 counties that did not have a psychologist in 1999 but did have a psychologist in 2005. 8
uted to the fact that while the number of psychologists has increased, so has the population of Texas. This compares to the supply ratio for psychiatrists in 1999 of 6.2 to 5.6 in 2005.
Furthermore, in 2005 there were 181 counties without a psychiatrist of which 152 were rural. To compare, psychologists were not presented in 112 counties of which 105 were rural. With a population of approximately 23 million, Texas’s shortage of mental health workers is nearing a critical stage. According to the Mental Health Association of Texas, half all Americans will experience a mental disorder sometime in their lives. In 2002, 4.3 million Texans had some form of diagnosable mental disorder. Of those, 1.5 million had a serious mental disorder which impaired their ability to function at work, school and in the community. It is well documented that for people with mental illness, access to effective medication is crucial to treatment success. SPRING 2006
Texas Psychologist
Of all the mental health professionals only one profession has the authority to prescribe medication. As it stands, there will be approximately 1,300 psychiatrists to care for half of Texas’s population that will experience a mental disorder sometime in their lives. Isn’t it time that we set aside our professional conflicts and start looking after our citizens? Texas needs more appropriately trained mental health professionals who are capable to prescribe medications. Are we just protecting “our turf ” or are we treating our clients in the best manner possible. Louisiana and New Mexico have passed legislation that allows other mental health providers to provide the best care for their patients and prescribe medication. One reason is because they saw the need to help their citizens gain access to mental health
providers. Do we have enough providers? The Texas Medical Association states that there is a strong correlation between where a physician completes his/her residency and where he/she chooses to practice. In 2005, 47.8 % of all psychiatrists practicing in Texas were from the eight medical schools in the state. 29% of the psychiatrists were graduates from foreign schools and 23% were from medical schools in the United States, but outside of Texas. In 2004 only 56% of physicians planned to stay in Texas after they completed medical school. In addition, there has been no growth in psychiatric residency training positions in Texas in the past 10 years mainly due to the capped Medicare support and the minimal state funding.
For the well being of every Texan, expanding scope of practice to allow more professionals to prescribe medication is good public policy that serves the citizens of Texas well.
Yes, there is a shortage of mental health professionals in the great state of Texas.
Publication No. 25-12347 E Publication No. E25-12347
* supply ratios are the number of mental health professional per 100,000 population. Source: Highlights of the Supply of Mental Health Professionals in Texas. February, 2006 A report produced by the Health Professions Resource Center, Center for Health Statistics and the Texas Department of State Health Services
WHEN YOU SEND A CLIENT TO HAZELDEN, YOU BOTH GET EXCEPTIONAL TREATMENT. You won’t find a more comprehensive treatment program for your clients. Or one that does more to partner with you. We treat young people, ages 14–25, keeping you involved every step of the way. And our full line of curricula and educational materials can help you in your practice. To learn more, call 888-355-6894. www.hazelden.org/helpingyouth
SPRING 2006
9
Texas Psychologist
Appreciating Diversity in Academic Settings Randy Noblitt, PhD James R. Noblitt, BA The Texas School of Professional Psychology at Argosy University/Dallas
Abstract Psychology and higher education are at a crossroads as they attempt to broaden their scope, accessibility, and relevance to underserved populations. This article addresses how the appreciation of diversity can be integrated into the mission of higher education and how psychology can serve the community by embracing this important goal. Examples of graduate programs that demonstrate inclusion and foster academic and social equality are provided as well as suggestions for developing and implementing academic and professional growth and collegiality among diverse groups. Included is a discussion of the implications of diversity on the future of psychology and how higher education can prepare us personally and professionally for multicultural sensitivity and competence.
Appreciating Diversity in Academic Settings When we hear the word diversity many of us think about race relations. The topic of diversity certainly includes race and racism, 10
but it also addresses many other issues. Multiculturalism is an important related concept. Corey, Schneider, and Callanan provide a broad definition of culture as inclusive of race and ethnicity as well as “gender, religion, economic status, nationality, physical capac-
ity or handicap, or affectional or sexual orientation” (2003, p. 111). A variety of other categories can be considered including the cultures of career, employment and political affiliation. Although many psychologists have made serious efforts to become more aware and thus sensitive to the diverse populations they serve, we continue to be challenged by an ever present and ongoing need to develop and expand our multicultural competence. Further, it is incumbent on each of us to encourage and welcome individuals from diverse cultures and backgrounds into the field of psychology (Farberman, 2005; Maton & Kahout, 2006; Rogers & Molina, 2006; Vasquez, Lott, Garcia-Vasquez, Grant, Iwamasa, et al., 2006; Vasquez & Jones, 2006). Greater diversity is needed within the SPRING 2006
Appreciating Diversity in Academic Settings
profession partly as a matter of social justice. It is unfair when higher education is predominantly available to particular elite social classes, races, and ethnicities. Empirical research supports the notion that providing psychological services to underserved populations may be enhanced by the availability of trained psychologists with similar cultural backgrounds (Wu & Windle, 1980). Thus, diversity within the profession is needed for this purpose as well. Although there have been some encouraging trends associated with the overall growth
oppressed people in a state of multigenerational poverty that further restricts their access to universities. Awareness of our multicultural reality challenges the status quo while raising relevant ethical concerns. Pope and Vasquez (1998) apprise clinicians of their twofold responsibility: On the one hand, the clinician must become adequately knowledgeable and respectful of the client’s relevant cultural or socioeconomic contexts…On the other hand, the clinician must avoid making simplistic, un-
It is incumbent on each of us to encourage and welcome individuals from diverse cultures and backgrounds into the field of psychology in the number of minority students attending and completing various psychology graduate programs since 1989, this growth may be leveling off within doctoral programs (Maton & Kahout, 2006). Ultimately the question becomes, how do we encourage individuals from diverse populations to enter the field? How do we effectively recruit and retain them? How do we appropriately challenge these students while guiding and nurturing them through the maze of EuropeanAmerican academic institutions? We also need to consider how to reduce or eliminate the elitist practices that have created barriers within psychology and higher education. This elitism combined with racism and unbridled capitalism has served to keep many SPRING 2006
founded assumptions on the basis of cultural or socioeconomic contexts. (p. 210) Culture is a complex phenomenon and diversity is not simply a matter of differences among groups. Individuals within all cultures are unique and there is often more within-group variability than variation between groups (Locke, 1998). The presence of subgroups and overlapping groups may complicate the picture further. Most importantly, we need to remember that each person is an individual who deserves to be treated with respect. When we rely on common cultural stereotypes we often fail to accurately comprehend others’ individuality. Most of us belong to, or have some identification with a variety of different cultures. Further, in our
multiracial, multicultural world, we may no longer be able to identify with a specific race or ethnicity or culture. Increasingly, many individuals identify themselves as biracial or multiracial.
Different Kinds of Diversity In addition to race and ethnicity, there are cultures associated with sexual preference including gay, lesbian, bisexual, transgender, and heterosexual orientations. Those who are not heterosexual may experience rejection, hostility, and even physical violence because their way of life is at variance with the majority culture and inconsistent with some religious beliefs. In a study by Liscz and Yarhouse (2005), the authors compared responses of 200 psychologists who were members of the Christian Association for Psychological Studies (CAPS), 200 psychologists who self reported that they were generalist clinicians (GEN), and 200 psychologists who identified themselves as specialists in the treatment of lesbian, gay and bisexual individuals (LGB). Each of the psychologist groups responded to four vignettes centering on a client who reveals same sex feelings. The three groups of psychologists differed significantly on what they considered a best practice treatment response. The CAPS psychologists responded with less endorsement of gay-affirmation, the LGB psychologists showed the least endorsement for supporting the client in changing the same-sex behaviors, and the GEN psychologists were more likely to endorse neutral responses. Kilgore, Sideman, Amin, Baca, and Bohanske (2005) collected data from questionnaires that would suggest that psychologists attitudes about LGB individuals is becoming increasingly affirmative, and that female psychologists are more accepting of nonheterosexuals than are male psychologists. In a survey of training directors at American Psychological Association (APA) accredited clinical and counseling PhD programs, Sherry, Whilde, and Patton (2005) found that both program models incorporated attention to 11
Appreciating Diversity in Academic Settings
LGB issues. However, counseling programs tended to require more multicultural courses in which LGB topics could be addressed as well as greater mentoring in LGB research. We also belong to different cultures associated with particular religious views or positions that are neutral, or generally reject traditional religious belief systems. Similarly people have different views about spirituality—or they may be aspiritual, what philosophers call the materialist monist position. A multicultural treatment of religion, spirituality and aspirituality has often been
seminal work, Sexual Politics (1968), Kate Millet asserted, “However muted its present appearance may be, sexual dominion obtains nevertheless as perhaps the most pervasive ideology of our culture and provides its most fundamental concept of power” (p. 25). This dominion is apparent within many facets of life and can be seen even in the helping professions. For example, within the male dominated field of medicine it has been noted that women may be vulnerable to mistreatment and neglect. In the area of mental health, women are more frequently subjected to
Given the constraints that Hopwood imposes on public universities in Texas, it is imperative that workable alternatives be developed in order to assure inclusion of minority students in higher education. overlooked in psychology training programs for fear that the topic might be used as an excuse for imposing one’s particular views on others. Nevertheless, religion, and the lack of it, represents a kind of culture and a crucial component to one’s identity. We need to develop sensitivity and cultural competency in this area. Similarly, people may have political views that constitute aspects of their individuality whereby they associate and identify with others with similar perspectives; thus political affiliations may also be viewed as cultures. Gender can be considered a cultural category. The Women’s Movement and feminism arose largely in response to the widespread and historic oppression of women. In her 12
electroconvulsive shock therapy, more likely to be institutionalized for psychiatric conditions, ascribed more serious diagnoses than males with the same symptoms, and more often prescribed psychoactive medications. Women’s psychological status is frequently interpreted in terms of sexist concepts and language (Laurence & Weinhouse, 1994). Kolb, Williams and Frohlinger (2000) write that women have been able to increasingly find opportunities for employment but their salaries continue to lag behind males in comparable positions. This inequity even persists among university faculty. The 20002001 Annual Report on the Economic Status of the Profession found that male faculty members were paid higher salaries than their
female counterparts reflecting “troubling and persistent differences in the salaries of men and women in academe over time. These differences persist if you control for rank, institutional category, and the public or private-independent status of the institution” (American Association of University Professors, 2002, Differences between men and women, ¶ 1). White people, particularly males, are often protected from the deprivation and inequity that others commonly encounter. Thus, there exists what is called White privilege (Rothenberg, 2002). Sue (2003) proposes that subtle but pervasive racism may represent more of a threat to people of color than overt racism, that many in the majority culture “fail to see” (also see Dalton, 2002). Sue (2003) and Feagin and Vera (2003) encourage individuals within the dominant culture to confront their own racism. Jones and Shorter-Gooden (2003) poignantly describe the experience of Black American women struggling with the expectations born of stereotypes perpetuated within and outside their own cultures. The authors conducted the African American Women’s Voices Project in which they disseminated a national survey and interviewed 333 Black women between the ages of 18 and 88, in 24 states and Washington, DC. Jones and Shorter-Gooden found that Black women accommodate to the varying expectations and demands of their friends, families, churches, schools, and careers by shifting their behaviors. In their efforts to navigate these inconsistent demands, they alter their appearance, expectations, demeanor, vocabulary, and speech according to circumstances, thus suppressing or obscuring their personal aspirations, desires, and needs and subsequently compromising their physical, emotional, and mental health. The authors conclude: What’s needed is a mutuality of accommodation between diverse groups. The more our misperceptions and prejudices break down, the more we come to understand and celebrate differences, the less shifting Black SPRING 2006
Appreciating Diversity in Academic Settings
women and other stigmatized groups will have to do. All people will have more freedom to be who they are, to accept themselves, and to contribute their unique voices and style to this nation and the world. (p. 280)
Emerging Trends It is noteworthy that the March 2006 issue of American Psychologist includes a special section devoted to the topic of diversity within our profession. In the first in this series of articles, Maton, Kohout, Wicherski, Leary and Vinokurov (2006) describe the trends for what they call the minority graduate pipeline from 1989 through 2003. As stated earlier in this paper, they found an encouraging trend for overall growth from 1989 to the present, but a recent lack of growth associated with doctoral programs. A second article by Melba Vasquez and James Jones (2006) discusses key issues in the controversy over affirmative action and possible avenues for increasing prospects for people of color in psychology. In particular, the need for advocacy and political action is stressed. A third paper by Margaret Rogers and Ludwin Molina (2006) identifies features of graduate programs that make exemplary efforts toward recruiting and retaining minority students. The fourth of the articles in this special section presents the personal reflections of the members of a panel discussion held during the National Multicultural Conference and Summit of 2003 on both the barriers and strategies for increasing diversity within psychology (Vasquez, et al., 2006). There have been obstacles to affirmative action in higher education and elsewhere (Vasquez & Jones, 2006). Two cases in particular have both clarified and complicated the law regarding minorities-sensitive admission policies. In University of California Regents v. Bakke, 438 U.S. 265 (1978), it was argued that denying admission to a qualified student solely on the basis of lack of affiliation with a minority population was unconstitutional under the Equal Protection guarantee of the Fourteenth Amendment. This SPRING 2006
position was reaffirmed by the U.S. Court of Appeals Fifth Circuit in its 1996 decision in Hopwood v. Texas. Before the Hopwood decision, the University of Texas essentially segregated applicants and used different criteria to evaluate minority applicants in an effort to approximate a student body that proportionally reflected the Texas population. After the Hopwood decision declared such a process to be illegal, most public institutions in the states covered by the Fifth Circuit felt constrained to continue using race/ethinicity as a basis for admission—and equally important, for scholarship award. To mitigate anticipated losses of Black and Hispanic students, Texas public universities opted for a Top Ten Percent Plan by which students graduating high school within the top 10% of their classes would gain automatic admission to one of the state’s public universities. However, the Ten Percent Plan has not performed as hoped and post-Hopwood enrollment of Blacks and Hispanics has significantly decreased from pre-Hop-
wood levels (Kain, O’Brien, & Jargowsky, 2005). Additionally, many public graduate programs in psychology have been put at a real disadvantage in recruiting students of color, in that administrative guidelines may dictate that to be in accord with Hopwood, they cannot even qualify for APA minority scholarships (which require matching funds from the institution).
Implementing Multicultural Policy Given the constraints that Hopwood imposes on public universities in Texas, it is imperative that workable alternatives be developed in order to assure inclusion of minority students in higher education. One program that has been relatively successful in recruiting and retaining minority students has been developed at Argosy University/Dallas. Although this is a private university, many of its approaches are generalizable. Rogers and Molina (2006) found the significant factors that encouraged minority participation in 13
Appreciating Diversity in Academic Settings
higher education were financial aid, personal contact with prospective students by faculty, active recruitment and retention of faculty and students of color, less reliance on GRE scores for admissions, and social support and mentoring. Argosy University/Dallas has integrated such elements in its policy resulting in a student population that approximates the diversity of the citizens of Texas. Of the 389 students enrolled at Argosy/Dallas in Spring 2005, 21% were male, 79% female, 49% White, 31% Black, 9% Hispanic, 3% Asian, and 8% unknown. In lieu of GRE test scores, admissions are based on a combination of past scholastic performance, grade point average (GPA), record of individual achievement, interviews by faculty committees, and written self-appraisal. Faculty take an active role in the recruitment and retention process by developing mentoring relationships with prospective and continuing students. After admission, intrafaculty communication facilitates the identification of and intervention with students who may be struggling academically. Student services includes the Academic Resource Center (ARC) to assist students both in remediating writing problems as well as refining writing skills, and developing professional communications style. The faculty is encouraged to have face to face contact with their advisees and strive to develop collegial relationships with each of them. Every effort is made to not merely retain students but to insure student success. Other universities, especially those in rural areas, have found that such extra efforts can make a program more attractive to diverse students. Having support groups in place for students of color or GLBT students, emphasizing ongoing mentor relationships, encouraging cohorts to bond and appreciate the diversity each student offers, and infusing diversity topics throughout the curriculum are suggested approaches.
Conclusions The American Psychological Association is clearly in support of programs and poli14
cies that advance the recruitment and retention of individuals from diverse populations. Along the same line, there is a need for curricula that train culturally sensitive and competent professionals. Legal decisions such as the Bakke and Hopwood impose limitations on public universities in Texas and other states, but private institutions have greater latitude in policy development. Both public and private institutions need to explore and develop methods of insuring and valuing diversity among faulty and students and in infusing diversity topics in the curricula. Some progress has been made but there is still considerable work to be done. There is a compelling need for all of us to be active in this effort.
References
and bisexual issues continue to improve: An update. (2005). Psychotherapy: Theory, Research, Practice, Training 42, 395 – 400. Kolb, D. M., Williams, J., & Frohlinger, C. (2000). Confronting the gender gap in wages. Womensmedia.com. Retrieved March 10, 2005 from http://www.womensmedia.com/new/confronting-gender-wage-gap.shtml. Laurence, L., & Weinhouse, B. (1994). Outrageous practices: The alarming truth about how medicine mistreats women. New York: Fawcett Columbine. Liszcz, A. M. & Yarhouse, M. A. (2005). Samesex attraction: A survey regarding client-directed treatment goals. Psychotherapy: Theory, Research, Practice, Training 42, 111 – 115. Locke, D. C. (1998). Increasing multicultural understanding: A comprehensive model (2nd ed.). Thousand Oaks, CA: SAGE Publications. Maton, K. I., & Kahout, J. L. (2006). Minority students of color and the psychology graduate pipeline: Disquieting and encouraging trends, 1989 – 2003. American Psychologist, 61, 117 – 131.
American Association of University Professors. (2002). 2000-2001 Annual report on the economic status of the profession. Retrieved March 10, 2006 from http://www.aaup.org/surveys/ 01z/z01rep.htm
Millet, K. (1970). Sexual politics. Garden City, NY: Doubleday & Company, Inc.
Corey, G., Schneider, M., & Callanan, P. (2003). Issues and ethics in the helping professions. Pacific Grove, CA: Brooks/Cole.
Rogers, M. R. & Molina, L. E. (2006). Exemplary efforts in psychology to recruit and retain graduate students of color. American Psychologist, 61, 143 – 156.
Dalton, H. (2002). Failing to see. In P. S. Rothenberg, (Ed.). White privilege: Essential readings on the other side of racism, (pp. 15— 18). New York: Worth Publishers. Farberman, R. K. (2005, November). Council moves to bolster APA’s diversity, among other actions. Monitor on Psychology, pp. 28 – 29. Feagin, J., & Vera, H. (2003). Confronting one’s own racism. In P. S. Rothenberg, (Ed.). White privilege: Essential readings on the other side of racism, (pp. 121—126). New York: Worth Publishers. Jones, C. & Shorter-Gooden, K. (2003). Shifting: The double lives of Black women in America. New York, NY: HarperCollins. Kain, J. F., O’Brien, D. M., & Jargowsky, P. A. (2005) Hopwood and the top 10 percent law: How they have affected the college enrollment decisions of Texas high school graduates. A Report to the Andrew W. Mellon Foundation. Retrieved on March 19, 2006 from http://www.utdallas. edu/research Kilgore, H., Sideman, L., Amin, K., Baca, L., & Bohanske, B. (2005). Psychologists’ attitudes and therapeutic approaches toward gay, lesbian,
Pope, K., & Vasquez, M. J. (1998). Ethics in psychotherapy and counseling, 2nd ed. San Francisco: Josey-Bass.
Rothenberg, P. S. (2002). (Ed.). White privilege: Essential readings on the other side of racism. New York: Worth Publishers. Sherry, A.,Whilde, M. R., & Patton, J. (2005). Gay, lesbian, and bisexual training competencies in American Psychological Association accredited graduate programs. Psychotherapy: Theory, Research, Practice, Training 42, 116 – 120. Sue, D. W. (2003). Overcoming our racism: The journey to liberation. San Francisco: Josey-Bass. Vasquez, M. J. & Jones, J. M. (2006). Increasing the number of psychologists of color: Public policy issues for affirmative diversity. American Psychologist, 61, 132-142. Vasquez, M. J., Lott, B., Garcia-Vasquez, E., Grant, S. K., Iwamasa, G. Y., Molina, L. E., et al. (2006). Personal reflections: Barriers and strategies in increasing diversity in psychology. American Psychologist, 61, 157 – 172. Wu, I. & Windle, C. (1980). Ethnic specificity in the relationship of minority use and staffing of community mental health centers. Community Mental Health Journal, 16, 156—168. SPRING 2006
Texas Law and the Practice of Psychology A Sourcebook By TPA Editors Code: XB-205
ISBN: 1886298203
Pages 256
$35.00
The Single Resource for the Legal Guidelines Shaping the Practice of Psychology in Texas. T Texas Law and the Practice of Psychology provides licensed psychologists, psycchology students, interns, and professors with the key legal and policy issues specific to the state of Texas today. Issues directly affecting all these practitios ners and their students have been carefully selected from statutes, case laws, n official archives of the Attorney General Opinions and Open Records Opinions o as well as synopses of the opinion letters of the Texas State Board of Examina ers of Psychologists. No other compilation of such critical, up-to-date material e exists for the state of Texas. e Quickly and easily find information that would usually take hours to track down. Practitioners and students alike will find comprehensive codes related to: • Civil Practice and Remedies • Human Resources • Education • Insurance • Family • Penal • Occupation • Health and Safety • HIPAA
For more information or to order, go to www.bayoupublishing.com and click on the books link or email orders@bayoupublishing.com or call 800-340-2034
Join one of TPA’s Special Interest Groups (SIG) or Divisions. Contact Amber Frausto at membership@texaspsyc.org to let her know if you wish to join. You must be a TPA member in order to participate. Aging Division
Binational Issues SIG
Forensic Practice Division
Child/Adolescent Issues SIG
Psychopharmacology Division ($10 dues required)
Gay/Lesbian/Bisexual/Transgender Issues SIG
Women in Psychology Division ($10 dues required)
Mental Retardation/Developmental Disabilities SIG
School Division
Psychology of Diversity Social Justice SIG
SPRING 2006
15
Texas Psychologist
Intervening with Complicated Bereavement: Lessons from the Scott & White Grief Study Louis A. Gamino, PhD, ABPP Kenneth W. Sewell, PhD
You may have heard the apocryphal story of the middle-aged adult who has become increasingly aware of personal mortality and so consults an internist about how to maximize longevity. “Doctor, what must I do to insure that I live a long life?” After a reflective pause, the doctor answers with a wry smile, “Pick healthy parents.”
T
he moral beneath the humor in this illustration is that many of the factors involved in living a long life are based on the physiology one is born with, i.e., one’s genetic pedigree. The strong survive longer and the weak die younger. When it comes to coping with bereavement, the parallel question would be, “What must I do to grieve well?” If the answer which follows is along the lines of “Possess an adaptive personality,” very little is gained from asking the question.
16
While it is reasonable to assume that those who are generally adaptive and resilient in life have the best probability of handling bereavement adaptively, knowing this does little to inform clinicians concerned with treating patients plagued by complicated bereavement. Therefore, concepts related to personality traits and typologies—dispositional optimism, internal locus of control, hopefulness, high self-efficacy, or personal hardiness—do little in and of themselves to advance the art of clinical practice with the bereaved.
Most clinicians have had therapeutic encounters with otherwise healthy people who are bereft and need some opportunity to ventilate their feelings, normalize their experience, organize their reactions, ask questions and/or receive support. These encounters illustrate what William Worden (2002) has called “grief counseling.” Usually such individuals fare well, are grateful for their interaction with mental health professionals, and leave the clinician feeling very competent about his/her clinical acumen and expertise. Like those fortunate people whose parents lived long lives and so can expect longevity for themselves, these individuals are among the majority of grievers who will ultimately adapt well to the stress of bereavement without any need of clinical services. More challenging for practicing clinicians is approaching those less fortunate individuals who were not blessed with personal resiliency or hardy egos and therefore have considerable trouble coping with loss. They are not adaptive by nature. Grief SPRING 2006
Texas Psychologist
and loss, along with other stressors, present terrible hardships in their lives. Or, the nature of their loss involves untold complications that make their grieving process tortuously difficult. For these cases, a clinician needs more detailed models of analysis to understand the extent of a griever’s problems and to devise treatment strategies that effectively address the sources of those complications. Under the aegis of the Scott & White Grief Study, we have conducted a series of research projects designed to elucidate the nature of complicated bereavement and to point the way toward understanding the behavioral elements of adaptive grieving. In the following sections, we will outline some of our major findings as they pertain to high risk factors in grieving, adaptive strategies, meaning making, and a clinician’s use of self.
High Risk Factors Making a thorough clinical assessment of a griever’s loss includes surveying for the presence of complicating conditions, referred to by Rando (1993) as high risk factors and by Worden (2002) as mediating variables. In Phases 1 and 2 of the Scott & White Grief Study (Gamino, Sewell & Easterling, 1998; 2000), we gathered information on several such high risk factors in order to determine empirically which ones were most often associated with higher levels of negative grief affect among the bereaved. We measured five high risk factors pertaining to the circumstances in which the death occurred: unexpectedness, trauma, younger aged decedent, shorter precipitant (i.e., the time interval between learning that a person was seriously ill/injured and the actual death), and preventability. The most robust predictor of distress was younger aged decedent, that is, a child or a younger person whose death seemed “off time” in the life cycle (cf. Neugarten, 1979). Deaths that occurred in traumatic SPRING 2006
fashion (e.g., shocking, horrific, violent, dismembering, or disfiguring) were also strongly associated with distress, as were deaths perceived to be preventable (e.g., due to negligence or medical malpractice). As an empirical variable, unexpectedness proved to be very nettlesome to categorize. Many times, grievers knew the death was coming in a longer time frame but still were very much surprised when the person actually died. Examples included deaths among patients with emphysema or cancer, wherein an opportunistic acute illness was the immediate (proximal) cause of death even though the underlying illness
basis to the reasoning that those who do not cope well with life in general will not cope well with bereavement in particular. Two other predictors—greater number of other losses and problematic relationship between mourner and decedent—were also associated with higher subjective distress in grievers. History of a problematic relationship with the deceased is especially significant clinically. Freud (1957) pointed to the difficulties in mourning that arise when the pre-morbid attachment to the deceased is characterized by ambivalence. Attachment theory is rich with hypotheses regarding
Making a thorough clinical assessment of a griever’s loss includes surveying for the presence of complicating conditions was the primary pathology. Our struggle to define unexpectedness empirically parallels the difficulty many individuals have anticipating a loved one’s death with clarity rather than denial. Even though many models of grieving consider denial normative, it is an important consideration in clinical treatment when it persists to the point of undermining later adaptation. Besides circumstantial factors, we also measured four high risk factors pertaining to characteristics of the mourner: problematic relationship with the decedent (i.e., conflict, ambivalence or extreme dependency), previous history of mental health treatment, number of other losses, and perceived social support. History of mental health treatment proved to be the most deleterious personal liability, giving empirical
how individuals bond to one another; how a person grieves when the loved one dies is a function of this attachment bond (Stroebe, 2002). When a problematic relationship preceded the death, clinicians almost certainly will have to address the survivor’s latent emotions toward the deceased and his or her complex internalizations of their relationship. Another high risk factor for complicated bereavement was discovered in a later study on funeral services (Gamino, Easterling, Stirman & Sewell, 2000). In our sample, there was a high incidence of “adverse events” (i.e., conflicts among survivors, issues with cremation, discrepancy between decedent’s wishes and survivors’ wishes, state of the body, problems with the funeral home, problems with the minister, or 17
Texas Psychologist
financial problems) that occurred around the time of the funeral. When such adverse events were associated with less comfort derived from funeral rites, subsequent distress was higher.
Advances in thanatology have yielded important breakthroughs regarding postbereavement personal growth (Hogan, Greenfield & Schmidt, 2001). Thus, despite the common negative emotions of sadness, anger, fear and guilt, grieving
sociated with four key behavioral correlates: finding some good resulting from the death; having a chance to say “goodbye”; higher intrinsic spirituality; and spontaneous positive memories of the decedent (Gamino et al. 2000). These findings present many possible avenues for clinical intervention with troubled grievers. As a beginning point, knowing the benefit of seeing some good resulting from the death opens the door to a broad range of reframing techniques within the psychotherapeutic dialogue. Assisting the mourn-
individuals who live through the loss of a loved one can emerge personally stronger, closer in their interpersonal relationships, and more appreciative of life (Frantz, Farrell & Trolley, 2001). How does a griever achieve this kind of post-bereavement personal growth? In Phase 2 of the Scott & White Grief Study, we explored the relation between empirically measured personal growth (Hogan et al. 2001) and several behavioral variables that could influence adaptation. We found higher scores on personal growth to be as-
er in recasting his/her story of death and loss to include the dimension of positive outcomes (in addition to sorrowful ones) could have highly salutary effects on the mourner’s emotional state and global sense of well-being. This could be a significant step in contextualizing the loss experience, restoring a sense of coherence to the griever’s life narrative (Neimeyer, 1998) and providing a psychological platform from which personal growth may ensue. Likewise, when there has been no adequate or satisfactory goodbye, even if the
Adaptive Strategies
18
mourner perceives that the opportunity to do so has been forever missed, the clinician can help educate the mourner about the many symbolic ways in which goodbye can be expressed in a constructive manner and the power of ritual as a vehicle for leave taking. Writing a letter of closure, visiting the gravesite, giving away clothing or personal effects of the deceased, or confiding in a compassionate relative or friend are but a few of the many possible ways in which an overdue goodbye can be conceived and carried out. Intrinsic spirituality (i.e., holding a set of beliefs or attitudes that places one’s relationship with a higher power at center stage and using a religious creed to organize life events and experiences , Allport & Ross, 1967), is an acquired life perspective. Experiencing loss may constitute a “reachable moment” in which a troubled mourner, with the assistance of a sensitive clinician, may be able to access dormant or latent intrinsic spirituality and utilize it to cope with the death of a loved one (Gamino, Easterling & Sewell, 2003). The value to mourners of holding positive memories of the decedent links with bereavement perspectives advocating a continuing relationship with the deceased (Klass, Silverman & Nickman, 1996). Instead of breaking the bond at death, this perspective favors emotionally relocating the deceased in a manner that both acknowledges the end of the former physical relationship and permits a continuing transformed relationship (Attig, 2000). Positive memories of the decedent, stimulated through a variety of strategies such as photographs, mementos, memorials or tributes, certainly may play a role in solidifying and maintaining such a transformed relationship.
Meaning Making The phenomenology of bereavement cannot be captured adequately through quantitative data alone. Therefore, in SPRING 2006
Texas Psychologist
Phase 2 of our research, we incorporated qualitative methods by asking participants to write an essay answer to the question, “What does the death of your loved one mean to you?” In a content analysis of the resulting narratives, nine unique meaning constructs or themes emerged. The most prominent theme was Feeling the Absence of the decedent. Additional themes included Experiencing Relief, Disbelieving the Death, Changing Relationships, Focusing on Negativity, Experiencing Meaninglessness, Continuing the Connection, Invoking an Afterlife, and Going on with Life (Gamino, Hogan & Sewell, 2002). Our set of nine meaning categories had several direct parallels to the typology discovered by Nadeau (1998) in her investigation of bereaved families. In considering what taxonomic structure may underlie this array of meaning constructs, we noticed a “natural congregation” among the various meaning categories according to the emotional valence they conveyed—namely, the categories seemed referent either to the pain and suffering of bereavement (i.e., Feeling the Absence, Disbelieving the Death, Changing Relationships-Negative, Focusing on Negativity, and Experiencing Meaninglessness) or to more positive hope and recovery dimensions of bereavement (i.e., Experiencing Relief, Changing Relationships-Positive, Continuing the Connection, Invoking the Afterlife, and Going on with Life). Ultimately, we tested whether this qualitative distinction between pain/suffering and hope/recovery bore any empirical relation to how participants scored on various quantitative measures. Indeed, participants who endorsed one or more positive constructs in their essays reported lower levels of grief distress and higher levels of postbereavement personal growth compared to those mourners who expressed exclusively pain/suffering categories in their essays (Gamino & Sewell, 2004). When combining our qualitative and SPRING 2006
quantitative data, we found much to ponder about clinical intervention with individuals suffering complicated mourning. Because the enterprise of psychotherapy is so embedded in narrative, an important clinical endeavor with troubled grievers could be helping them explore or elaborate any aspects of their loss experience pertaining to hope and recovery dimensions, either by “listening for” possible indications of this or by introducing such constructs through gentle suggestion. Such “co-constructing” of ultimate meanings assigned to personal experiences such as loss has been described in the narrative processes model of psychotherapy (Angus, Levitt & Hardtke, 1999). Ultimately, it may facilitate measurable declines in grief misery and/or augment post-
worst kind. A 30-year-old mother of two preschool age children was widowed when her husband died of a heart attack less than an hour after first complaining of feeling ill (he had no prior history of heart disease). Because she was completely grief stricken, her church members arranged for an appointment with a mental health clinician the day after she buried her husband. She arrived at the appointment with no idea how to proceed and was met with the opening question, “What is it that you think is wrong with you?” The consultation went downhill from there. The clinician’s posture and inquiry discouraged expression of emotion and mini-
The clinician must be “comfortable,” therapeutically speaking, with matters of death and loss. bereavement personal growth, as suggested by our results.
Clinician’s Use of Self As with any delicate subject, the clinician’s personal experience with loss and bereavement can be a major factor in how effectively he/she is able to intervene in cases of complicated mourning. Having integrated one’s own loss experiences as well as being able to tolerate the strong emotions evoked by grief are crucial to a clinician’s ability to conduct a tactful yet thorough inquiry. Unfortunately, an interview from Phase 3 of the Scott & White Grief Study (an ongoing investigation of the behavioral characteristics of adaptive grievers) shows a clinical example of empathic failure of the
mized the nature of her loss. Emotionally crushed by her husband’s sudden death and bewildered at the prospect of supporting and raising two young children alone, the young widow found no empathy, no compassion, and no guidance—in short—no help. Not surprisingly, she never went back. In choosing to work with cases of complicated bereavement, it is incumbent upon the mental health clinician to be prepared to navigate the emotional cross-currents of grief without letting his/her own denial or defenses interfere with the mourner’s ability to express pain, search for meaning, and try to grow and adapt. That means the clinician must be “comfortable,” therapeutically speaking, with matters of death and loss. 19
Texas Psychologist
Summary When intervening psychotherapeutically with those suffering complicated bereavement, there is much to be learned from the results of the Scott & White Grief Study. Starting with a thorough assessment of high risk factors for complicated bereavement, the clinician discovers dimensions of the loss experience that require focus in psychotherapy (e.g., when the death was untimely, unexpected, traumatic or preventable) or characteristics of the griever that inuence the treatment plan (e.g., history of mental health problems, problematic relationship with decedent). Understanding potential pathways to attaining post-bereavement personal growth opens many possibilities in the psychotherapeutic dialogue, particularly when the clinician’s ear is attuned to meaning constructs associated with recovery/hope versus pain/suffering. Finally, for the clinician to intervene effectively with complicated bereavement, he/she is well-advised to come to terms with his/her own mortality and losses. In closing, we return to our trigger question, “What must I do to grieve well?â€? Fortunately, empirical research is generating many speciďŹ c behavioral strategies that enhance the likelihood of an individual grieving adaptively. Rather than ďŹ nding a formulaic or unitary pathway, evidence is emerging of multiple methods for coping with loss so that the answer to the question
0ARTNERING 7ITH 9OU IN THE 4REATMENT OF %ATING $ISORDERS
is, literally, “There are many ways you can learn to adapt well after the death of your loved one.� And so the therapeutic conversation begins.
References Allport, G.W., & Ross, J.M. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5, 432-443. Angus, L., Levitt, H., & Hardtke, K. (1999). The narrative processes coding system: Research applications and implications for psychotherapy practice. Journal of Clinical Psychology, 55, 1255-1270. Attig. T. (2000). The heart of grief: Death and search for lasting love. New York: Oxford University Press. Frantz, T.T., Farrell, M.M., & Trolley, B.C. (2001). Positive outcomes of losing a loved one. In R.A. Neimeyer (Ed.), Meaning reconstruction and the experience of loss. Washington, DC: American Psychological Association. Freud, S. (1957). Mourning and melancholia. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 239-260). London: Hogarth Press. (Original work published 1917) Gamino, L.A., Easterling, L.W., & Sewell, K.W. (2003). The role of spiritual experience in adapting to bereavement. In G.R. Cox, R.A. Bendiksen, & R.G. Stevenson (Eds.). Making sense of death: Spiritual, pastoral, and personal aspects of death, dying and bereavement (pp. 1327). Amityville, NY: Baywood. Gamino, L.A., Easterling, L.W., Stirman, L.S., & Sewell, K.W. (2000). Grief adjustment as inuenced by funeral participation and occurrence of adverse funeral events. Omega, 41, 79-92.
7E RECOGNIZE THAT NOT ALL EATING DISORDER CLIENTS NEED INPATIENT TREATMENT (OWEVER WHEN A HIGHER LEVEL OF CARE IS REQUIRED WE HOPE YOU WILL ENTRUST YOUR CLIENT TO US 2EMUDA S "IBLICALLY BASED PROGRAMS TREAT PATIENTS OF ALL FAITHS AND PREPARE THEM FOR COMPLETE RECOVERY WHEN THEY RETURN TO YOU FOR CONTINUED OUTPATIENT TREATMENT
20
Gamino, L.A., Hogan, N.S., & Sewell, K.W. (2002). Feeling the absence: A content analysis from the Scott & White Grief Study. Death Studies, 26. Gamino, L.A., & Sewell, K.W. (2004). Meaning constructs as predictors of bereavement adjustment: A report from the Scott & White Grief Study. Death Studies, 28, 397-421. Gamino, L.A., Sewell, K.W. & Easterling, L.W. (1998). Scott & White Grief Study: An empirical test of predictors of intensiďŹ ed mourning. Death Studies: 22, 333-355. Gamino, L.A., Sewell, K.W., & Easterling, L.W. (2000). Scott and White Grief Study—Phase 2: Toward an adaptive model of grief. Death Studies, 24, 633-660. Hogan, N.S., GreenďŹ eld, D.A., & Schmidt, L.A. (2001). The development and parametric testing of the Hogan Grief Reaction Checklist. Death Studies, 25, 1-35. Klass, D., Silverman, P.R., & Nickman, S.L. (Eds.). (1996). Continuing bonds: New understandings of grief. Washington, DC: Taylor & Francis. Nadeau, J.W. (1998). Families making sense of death. Thousand Oaks, CA: Sage. Neimeyer, R.A. (1998). Lessons of loss: A guide to coping. New York: McGraw Hill. Neugarten, B. (1979). Time, age, and the life cycle. The American Journal of Psychiatry, 136, 887-894. Rando, T.A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press. Stroebe, M. (2002). Paving the way: From early attachment theory to contemporary bereavement research. Mortality, 7, 127-138. Worden, J.W. (2002). Grief counseling and grief therapy (3rd Ed.). New York: Springer.
7E HAVE DEVELOPED TOOLS TO ASSIST YOU IN PROVIDING ONGOING TREATMENT SUCH AS OUR ONLINE 0ROFESSIONAL .ETWORK %DUCATIONAL #ONSULTATION 3ERVICE %DUCATIONAL ,UNCHEONS AND 4HE 2EMUDA 2EVIEW 4HE #HRISTIAN *OURNAL OF %ATING $ISORDERS
1-800-445-1900 • www.remudaranch.com
7HEN YOUR CLIENT NEEDS INPATIENT TREATMENT CALL 2EMUDA 2ANCH "Y PARTNERING TOGETHER WE CAN MAKE RECOVERY A REALITY
SPRING 2006
CBT FOR INSOMNIA CLINICAL TRAINING WORKSHOP The National Insomnia Institute Clinical Training Workshop on CBT for Insomnia Insomnia is the most prevalent sleep disorder, affecting 15-33% of the population. Insomnia is currently being inadequately addressed and treated despite the explosive growth in the number of sleep clinics and laboratories in the United States. Although cognitive-behavioral therapy (CBT) is now considered the first-line treatment for chronic insomnia due to its superior long-term efficacy, lack of side effects, and patient preference it is still a far more underutilized treatment option compared with pharmacotherapy. This is in part due to a dire shortage of clinicians and sleep clinics with expertise in CBT for insomnia due to a scarcity of training opportunities in this area. The purpose of this Clinical Training Workshop on CBT for Insomnia is to enable clinicians to develop competence in CBT for insomnia using an empirically and clinically validated CBT program based on the treatment of several thousand insomnia patients at Harvard Medical School and the University of Massachusetts Memorial Medical Center. This clinical training workshop is intended for: x
Psychologists, psychiatrists, PCPs, sleep professionals, nurses and social workers who wish to develop expertise in CBT for insomnia for use in their practices; to increase referrals and to facilitate affiliations with sleep clinics
SPONSORED BY: NATIONAL INSOMNIA INSTITUTE
nationalinsomniainstitute.com
TEXAS SCHOOL OF SLEEP MEDICINE & TECHNOLOGY
The full day clinical training covers: x Physiology of insomnia and current research on CBT x Assessment of patients and potential clinical issues x Rationale for, and clinical application of, CBT techniques including cognitive restructuring, sleep scheduling, stimulus control, relaxation, sleep hygiene, and medication tapering techniques x Sleep medications Each participant receives: x A detailed training manual for subsequent use in clinical practice x Detailed, step-by-step treatment manuals for both a group and individual 5 session CBT program x Key program materials (sleep diaries, PowerPoint Slides, etc.)
FOR INFORMATION: 866-614-6007 www.NationalInsomniaInstitute.com
texassleepschool.com
Price : $675 June 3, 2006 SAN ANTONIO, TEXAS
Texas Psychologist
Relational Psychotherapy Supervision: A Shared Supervision Story Roderick D. Hetzel, PhD and A. Sydney Kroll, MS Baylor University Correspondence for this article should be addressed to Roderick D. Hetzel, Ph.D., Baylor University, One Bear Place, #97060, Waco, Texas, 76798-7060, Rod_Hetzel@baylor.edu
Relational Psychotherapy Supervision: A Shared Supervision Story The present article proposes that attending to the relational dimension of psychotherapy supervision, rather than focusing solely on skill development and case conceptualization, can facilitate the professional and personal growth of the supervisee, and, serendipitously, the supervisor. We first present the foundational principles of relational-cultural theory as a conceptual model for understanding relational psychotherapy supervision. We then discuss experiences from our own supervisor–supervisee relationship as a heuristic case study of relational supervision. It is our hope that this shared supervision story illustrates how relational learning can enrich supervision and, in turn, empower both supervisee and supervisor.
Relational–Cultural Theory Relational-Cultural Theory (RCT) offers a useful conceptual model for understanding the relational dimension of psychotherapy and supervision. At the core of RCT is an 22
assumption that psychological problems are firmly rooted in the fundamental paradox that all people long for authentic connection with others, but are so fearful of being hurt in relationships that they have learned
to keep significant parts of themselves out of relationship to protect themselves and the relationship (Miller & Stiver, 1991). This conflict, termed the central relational paradox, asserts that people simultaneously desire and dread connection. Although connection certainly holds the promise of acceptance and affirmation, the associated vulnerability contains potential perils of abuse, neglect, and other relational injuries. How do people balance their competing needs for connection and disconnection? RCT asserts that this inner conflict fuels the development of strategies of disconnection that allow us to maintain enough connection with others to avoid the pain of psychological isolation but also enough disconnection to minimize the pain of shame, humiliation, and other relational violations (Miller & Stiver, 1994). This basic conflict is expressed as a ongoing process of moving in and out of varying degrees of connection and disconnection within a relationship. It is recommended that therapists honor strategies of disconnection by empathizing with both sides of the SPRING 2006
Relational Supervision
paradox. This helps therapists to develop a deeper understanding of the profound fears that are associated with expressing our longings for connection and putting aside our strategies for disconnection. If the movement in and out of connection is conceptualized as a relational dance, then the specific steps of the dancers are influenced by their relational images and controlling images. Relational images are the inner mental constructions created and refined through our relational experiences, allowing us to organize our expectations and interpretations of relationship events (Miller & Stiver, 1995). Relational images are strongly influenced by sociocultural forces that are internalized as controlling images (Collins, 2000; Walker & Miller, 2000). Derived from our memberships in culturally-defined groups— with some groups arbitrarily assigned value by our society as better or more desirable than others—controlling images “define who and what we each are…they determine what is acceptable and what is not, what people can do and cannot do” (Miller, 2002, p. 2). Controlling images contribute to the development of restrictive relational images (e.g., “real men don’t cry” or “women should not be too assertive”), limiting our choices in relationships and overall relational flexibility. RCT proposes that psychological growth occurs within growth-fostering relationships in which people move out of disconnection and into connection with another person (Miller, 2002). Eldridge and colleagues (2003) noted that in the face of disconnection, a person “feels, along with isolation, a sense that she is the person at fault; she cannot be heard or understood; and she is powerless to change the situation” (p. 2). In contrast, authentic connection promotes relational resilience and psychological growth. The process of connections, disconnections, and new connections allows people to internalize new relational experiences by transforming restrictive images into more adaptive ones. RCT has identified two elements of connection that provide the cornerstones SPRING 2006
for growth-fostering relationships: mutual empathy and mutual authenticity. Jordan (2002) described mutual empathy as communication of the empathic response of the therapist back to the client, demonstrating that the therapist has been personally impacted by the experiences of the client. (Note: the term does not mean that the client should empathize with the therapist.) Walker (2004) described the impact of mutual empathy: The client must know that not only can the therapist “take in” his or her experience, but also that this experience actually matters in the relationship with the therapist. Given the understanding that isolation is a primal source of human suffering, the therapist’s failure to acknowledge the client’s impact may trigger feelings of shame and relational ineptitude in the client—perhaps similar to previous experiences of being in the presence of a more powerful, nonresponsive person. (p. 11) RCT conceptualizes mutual empathy not as a clinical technique that needs to be employed before the work of therapy can begin, but as the actual work of therapy. Mutual empathy is a relational oasis in a desert of disconnection. It shows clients that someone has heard, understood, and been moved by them, and in the process creates a profound felt sense of being acknowledged, accepted, and affirmed. By definition, mutual empathy assumes mutual authenticity. As described by Miller and colleagues (2004), mutual authenticity does not involve spontaneous or reckless disclosure of personal information, denial of the professional role and responsibilities of the therapist, or a “fifty-fifty” relationship in which therapists have permission to express or act upon their own needs. Mutual authenticity means being fully present and engaged in the relationship with the client. Therapists are not, and never can be, impartial or dispassionate automatons devoid of personal reactions. Contrary to traditional stances of therapeutic neutrality, therapists in fact are
personally impacted—sometimes profoundly—by the therapeutic relationship. Nor does mutual authenticity alter the fact that therapy exists for the sole purpose of helping the client. Jordan (2004) asserted that mutual authenticity is a “delicate, thoughtful process of being real while also being guided by clinical judgment” (p. 24). It is informed by a total commitment to the welfare of the client and the ethical standards of one’s profession. RCT proposes that mutual empathy and authenticity lead to the mutual empowerment of both (or all) members of the relationship (Miller & Stiver, 1991). When we bring our insecurities and vulnerabilities to mutually empathic and authentic relationships, we can more easily accept disowned—or more accurately stated, disconnected—parts of ourselves and are empowered to “overcome hardships, turmoil, and adversities” (Eldridge et al. 2003, p. 5). Miller (1988) described five good things that result from the mutual empowerment of growth-promoting relationships: increased zest, motivation and ability to take action in the relationship, increased knowledge of self and others, increased self-worth, and desire for more connections. These qualities are the desired outcome of psychotherapy as well as the “features which occur at many steps along the way whenever patient and therapist engage in a growing connection” (Miller & Stiver, 1991, p. 2). Further, as implied by the term mutual empowerment, these positive qualities of growth-fostering relationships may also be experienced by the therapist as well as the client.
Relational Psychotherapy Supervision After reviewing the foundational principles of RCT, one may ask how RCT is relevant to psychotherapy supervision any more than other theoretical frameworks or models of supervision. The recent literature on empirically-supported relationships has illustrated the importance of the therapeutic relationship in psychotherapy outcome (cf. 23
Relational Supervision
Hubble, Duncan, & Miller, 1999). Noting that psychotherapy involves more than the delivery of technical skills, Safran and Muran (2000) explained the rationale for addressing relational dynamics in supervision: Therapists require a basic capacity for self-acceptance (or at least an ability to work toward it), as well as the willingness and courage to face their own demons and engage in an ongoing process of self-exploration and personal growth. They also require certain basic skills, including interpersonal sensitivity, perceptiveness, and tact, as well as the capacity for intersubjectivity … Related to this is the capacity to engage in genuine dialogue with the patient, through which therapists are willing to challenge their own preconceptions. (p. 205) Although supervised practice, didactic instruction, group discussions, and observational learning are necessary components of psychotherapy training, alone they are not sufficient to help trainees “develop the combination of procedural knowledge, selfawareness, and reflection-in-action skills necessary to respond to patients in a flexible and creative way” (p. 206). RCT provides a conceptual model for addressing the relational dimension of supervision and promoting the kind of relational learning that is essential in becoming a psychotherapist. To date, only one article has been published on the application of RCT to psychotherapy supervision (Jordan, 2004). Focusing on relational learning in a consultation group of experienced therapists and not directly addressing the supervisor–supervisee relationship more typical of psychotherapy training programs, Jordan offers principles to inform the practice of relational supervision. First, supervision should occur in an environment of safety, respect, and mutual learning that promotes the supervisor’s vulnerability and minimizes the supervisee’s shame. Second, supervisors should be attuned to power dynamics in the supervisory relationship and the broader culture that may restrict supervisees from freely expressing themselves. Third, 24
supervision should respect the complexity of the healing process and recognize the limitations of our knowledge, with supervisors adopting a collaborative, rather than a “power-over,” position with their supervisees. The primary goals of all psychotherapy supervision models appropriately are to provide quality clinical services to clients and to facilitate the learning and professional development of supervisees. An additional goal of relational psychotherapy supervision— one that enhances the primary supervision goals—is movement-in-relationship towards authentic connection between the supervisor and supervisee. The supervisor-supervisee dyad becomes the focus of supervision, and the source of learning and development is located in the relationship rather than the person of the supervisee or supervisor. We propose that the major tasks of relational supervision include (a) establishing the supervisory relationship as a central focus of supervision; (b) recognizing the role of the central relational paradox and honoring strategies of disconnection; (c) understanding the influence of relational and controlling images and acknowledging (if possible, minimizing) the role of power dynamics in supervision; and (d) fostering mutual empathy, authenticity, and empowerment in the supervisory relationship. These tasks are less likely to be accomplished within a strictly hierarchical, “objectively-distant” expert position that is often endorsed by traditional supervision (and psychotherapy) models. Instead, supervisee and supervisor must work together to acknowledge the relational dimension of supervision and take a risk to impact and be impacted by each other.
A Shared Supervision Story To provide an illustrative case example of relational learning in supervision, we now turn to our own supervisor–supervisee relationship that developed through a doctoral-level clinical psychology practicum at a university counseling center. Inspired by Yalom and Elkins (1990), we decided early
during supervision to keep private journals that documented our personal reflections on the hidden life of supervision—those thoughts, feelings, insights, and other inner meanderings which never were discussed but which surfaced in one form or another in the supervisory relationship. We agreed to share our journals only with each other, and to prevent a potentially-harmful multiple relationship, to do so only upon completion of the practicum and all associated evaluations. We also decided that any public dissemination of journal content would be done only with mutual approval and consent. Based upon our journal entries and subsequent discussions, the following reflections highlight our own perspectives as we sought to navigate together the major tasks of relational supervision.
A. Sydney Kroll, MS (Supervisee) I was excited to start supervision with Dr. Hetzel because I wanted to put more of an emphasis on the relational and process components of my therapy. I had been fascinated with these aspects and realized I needed to practice and explore this with feedback from someone outside of session. During an early supervision session, he processed that perhaps something my client was experiencing was resonating with my own past experiences. This was true, and was something I had thought extensively about and explored in my own therapy. However, it was also something very personal and something I felt was no longer an integral part of my identity. His abrupt and unexpected identification of this experience was frightening. I found myself feeling defensive and trapped. Throughout this rupture I wondered if I had a banner on my forehead proclaiming to the world what I had experienced. Was I that transparent? Should I acknowledge this in my history, thereby acknowledging it again as a part of who I am, or should I deny it? Did this warrant my expressing such a private disclosure to my supervisor? Would SPRING 2006
Relational Supervision
such a disclosure have a negative impact on the supervisory relationship? I didn’t want to be labeled by something that happened in the past. I wondered where would we go with that line of discussion, but I didn’t want to look resistant to exploring issues that impacted my work with clients. This was a very uncomfortable and frustrating time for me. I wondered how to balance being open and willing to explore the process while maintaining my own self-preservation. I guess I was worried that someone would realize I was missing something more important than learned skills—that inherent feeling of “being a therapist.” I realized that I had wanted to learn about interpersonal process, but never considered that I would experience it within supervision. In fact, a “supervisory relationship” was not a concept with which I had been familiar. My feelings during this rupture included shock, confusion, anger, guilt, disappointment, and “stuckness” in the process. We gave each other time to struggle independently with the rupture and didn’t push each other either too far away or too close too soon. Dr. Hetzel honored the fact that I was uncomfortable and needed some time to get used to the process, and I tried to trust in his knowledge and care for me to continue to take risks. By his honoring the disconnection that occurred between us, I was able to realize that not taking responsibility for my own feelings kept me focusing on my hurt, instead of on working through the process. Eventually, this began to frustrate me. By the end of this process, I had found a way to begin to express my needs to Dr. Hetzel. Luckily, we were able to process this later on and gain an even deeper understanding and connection from the shared experience. The relational aspect of the supervisory relationship is where the real work is often done, and it is this aspect that was the most powerful for me. With the inherent power differences in the relationship, I entered supervision feeling unable to take risks for fear that I would make a mistake and be judged. SPRING 2006
However, Dr. Hetzel’s efforts to foster mutual empathy, by discussing how he was personally impacted by me and my work, and sharing his own experiences and reactions with clients, created a space in which I felt increasingly empowered to take risks and to begin to practice using my voice as a therapist. I was increasingly comfortable acknowledging, both to myself and to him, my personal reactions to our interactions, which I believe in turn empowered him as well. These interactions helped me to notice my own controlling and relational images and how these impacted our relationship. For me, I think our differences in religion, gender, and education status were the most salient. Students will likely have “power-under” controlling images from the beginning because of the status differences between supervisor and supervisee. These are then compounded by any other power differentials, like race, gender, or class. But explicitly talking about our controlling images and differences made them obsolete. Even in the face of significant differences, we were able to develop connection and find common ground based on authenticity. This dance of connection and disconnection led to mutual empowerment that allowed us to acknowledge and eventually move beyond our own controlling images. So many times I felt energized and excited after leaving supervision, even when we had an emotionally exhausting session or when dealing with draining clients. At first I felt embarrassed by this feeling, which made me withdraw. I think this was due to my personal tendency to move away from connection while at work in order to protect the image of myself as a competent and mature therapist. I think the majority of my embarrassment was coming from my belief that we, as clinicians, should not benefit personally from therapeutic (and thus supervisory) relationships. I thought that to do so would have been a violation of the strict boundaries of our profession. I’ve come to realize this energy was a result of the movement in the
supervisory relationship towards more authentic connection. I had more enthusiasm and energy to work with clients because I myself was working in a safe, genuine, and mutually-empathic environment. I felt more at ease with clients, more willing to take risks with them, and more aware of the underlying process dimensions. My trust in the process of therapy was also increased, as I had experienced a process of moving into a growthfostering relationship myself. Through supervision I also gained a much better knowledge of myself. I since have said numerous times that I grew more, both as a person and as a clinician, in this semester of clinical work and supervision than I have at any other time in my life. I believe this is in part due to an increased awareness, understanding, and appreciation of myself and who I am as a person and as a therapist. I also came to feel very appreciative of Dr. Hetzel, again both as my supervisor and as a person. Though I initially felt disempowered, the focus on the relational dimension allowed me to make a commitment to my personal and professional growth, and to the process itself. This included taking personal risks, tolerating ambiguity and uncertainty, and beginning to find my voice as a therapist, a supervisee, and a person. I also noticed that I became more relationally active with my clients, no longer allowing them to escape unnoticed from genuine connection but rather gently holding them in authentic engagement. For students, an increased sense of self– worth may be the most salient consequences of a relational model of supervision. In part because of my stage of professional development (and in part because of my own personal schemas!), I began this supervisory experience very doubtful of my clinical abilities and, perhaps most detrimental, my personal value. This often resulted in my getting in my own way in session and not allowing myself as a person to impact and be impacted by my clients. This also served as the primary resistance to a relational process. However, the experience of being encouraged to take risks 25
Relational Supervision
and appreciated for my unique contributions to the therapy and the supervision process was empowering. I learned that, as Dr. Hetzel is fond of saying, I am a good therapist not in spite of, but because of my strengths, weaknesses, and contradictions. This increase in a sense of worth as a therapist in turn increased my sense of worth as a person. Relational supervision also gave me a greater desire for more connection with others. My friends, colleagues, classmates, and family members became aware of a significant change in my style of relating as this experience unfolded. While I intellectually understood the importance and value of relationships, my own strategies of disconnection remained as protection against the risks of connection. However, in this and subsequent experiences, I developed a passion for connection that extends beyond my clients to every aspect of my life. Supervision gave me the opportunity to experience a mutually-empathic relationship in which my being is appreciated and encouraged. That is where the zest comes from, and that is why I have grown trustful of the process. And, that is what I want to extend to my clients. Roderick D. Hetzel, Ph.D. (Supervisor) When I started supervision I was excited about working with someone who was clearly intelligent and enthusiastic. But I also was quite anxious about my own skills and abilities, both as a therapist and a supervisor. It had been a long time since I had done full-time practice, and even longer since I had supervised anyone. Would she, the supervisee, know more than me, the supervisor? Would I appear foolish, ignorant, or outdated? My concerns had more to do with my own insecurities, my controlling images of what a supervisor was supposed to look like and act like. I knew that I would need to challenge assumptions that I needed to have it all together, and work on owning—and expressing—my own humanity and fallibility. A disarming—but ultimately transforming—phase of supervision occurred during 26
an early rupture. Sydney had a client struggling with some issues that seemed to trigger a personal reaction in her. She was less relaxed with this client and had a hard time talking about it with me. Trying to address this in a helpful way, I wondered aloud if she ever had experienced similar feelings or situations as this client. Even as the words came out of my mouth—too many words for such a straightforward query, thanks to my anxiety—I realized that it sounded awkward. Sydney made a good faith effort to respond to my question, but it clearly required more self-disclosure than she was comfortable with. I left supervision feeling like I had opened a can of worms. I had the suspicion that not only did she not want me to open the can, but she didn’t even want me to know that she had the can! Sydney seemed very guarded during our next few supervision sessions and reluctant to talk about her inner reactions to clients. We were in the midst of the rupture! In hindsight, I realized that the rupture was actually our rupture. Although Sydney may have responded to her anxiety with increasing disconnection in our relationship, I also had played a role, out of my own fear of appearing incompetent, by confronting her too quickly. Our rupture was a manifestation of the central relational paradox, with our own relational and controlling images pushing and pulling us in and out of connection and disconnection with each other. We spent some of our time over the next few weeks delicately talking about boundary issues. To her credit, Sydney was able to tell me after a few sessions that she felt I had pushed too far by asking her to talk about something that she was not ready to discuss. I wanted to respect her boundaries to not talk about this issue and to help her feel safe in the supervisory relationship, trusting that it would surface again if it were something that we needed to address. This was the hard work of honoring strategies of disconnection: her disconnection strategies triggered my own anxiety and disconnection, which
at first limited my relational flexibility and ability to “hold” the relationship. But by respecting her need for more relational distance—which involved spending more time on the traditional tasks of supervision—she came to feel validated and affirmed. This in turn led to a gradual shifting of her relational and controlling images, and her eventual empowerment to move out of disconnection and into connection. As I reflect on our rupture, I also am reminded of how important it is for supervisors to find ways to tolerate the ambiguity that comes from engaging in this relational dance with their supervisees. There was a noticeable ebb and flow to our connection during this time. The disconnection stirred within me feelings of doubt, frustration, and insecurity. I was confused about what was happening in the relationship, and had a nagging sense—despite my regular consultation with colleagues—that I was source of the problem. In short, I felt disempowered. These feelings were amplified by my own controlling images which dictated that supervisors be perfect, infallible, and sagacious. Such well-entrenched internalizations are not easily abandoned, but if I was going to help Sydney work through her own struggles with perfection and control, then I also had to accept and work through my own needs. It challenged me to give up those images that provided me with a false security, an illusion of security and safety in the relationship. For me, I was able to summon the needed resilience during the early stages of the rupture through my own personal and professional relationships outside of supervision. As we repaired the rupture, we began to experience mutual empathy and authenticity as well as more consistent connection. Supervision did not focus equally on our needs, but it did acknowledge that we were fellow travelers on a shared journey along roads of connection and disconnection. My self-disclosures were mostly ahistorical, focusing on the immediate moment. She SPRING 2006
Relational Supervision
didn’t learn as much about the “me in the past” as she did about the “me-in-the-moment.” It was empowering for both of us to have the freedom to be ourselves—to say “I don’t know” and work together to find an answer—rather than project a façade (evidence of our gradually shifting relational and controlling images). This gave us both the freedom to make more mistakes, which paradoxically led to greater effectiveness. The supervisory relationship generated a synergistic energy that led to increased creativity, productivity, and personal satisfaction. An expected outcomes of supervision was that Sydney became an effective therapist and she learned how to help her clients, which of course was the primary goal of supervision. But the mutuality in the supervisory relationship also gave Sydney the freedom to “come into voice” as a therapist: she became much more open and accepting of herself, showed greater awareness and comfort talking about her internal reactions, and was more willing to fully enter into relationship with her clients and with me. Supervision gave her the experience of participating in a growth-fostering relationship which she was in turn able to offer her clients. I think one reason that she was able to grow was her courage and willingness to engage in honest introspection. But another reason was that the person who held more power in the relationship (me) was willing to put aside the “power over” position and risk transparency and vulnerability with the person with less power (Sydney). It is interesting that the mutuality I tried to develop in our relationship—for the main purpose of helping Sydney find her voice as a therapist—also gave me with the same freedom to find my own unique voice. We both grew as persons, felt valued and empowered through our relationship, and experienced a zest and vitality in supervision that carried over into other areas of our lives. Supervision was challenging for me, but not in the way that I anticipated at the SPRING 2006
outset. It turned out that the challenge involved learning how two flawed people can develop and maintain a mutually empathic and authentic supervisory relationship with each other. Together, sometimes willingly and sometimes less so, we struggled through the messy process of doing messy work with messy people. Sydney learned how to be a better therapist. I learned how to be a better supervisor. We both learned how to be better people. And I suppose that is the transformation which occurs at the heart of mutuality. Interestingly, what I hoped most for Sydney—that she would recognize that it is her strengths and her weaknesses, her gifts and her limitations, her convictions and her contradictions that give her value as a person and make her a competent professional—are the very same truths I realized about myself.
Summary Many topics that were only briefly addressed in this article (e.g., boundary issues, power and control, shame and vulnerability, relational resilience and competence) warrant additional exploration and refinement. Future articles also should articulate the principles and practices of relational psychotherapy supervision. It is our hope that the reflections in this article illustrate how the rich and complex inner worlds of supervisee and supervisor, which lie just beneath the veneer of skills-based training and clinical formulations, invariably shape the ebb and flow of the supervisory relationship. Whether acknowledged or not, supervisor and supervisee engage in a relational dance as they attend to the professional work of supervision as well as the more personal (yet rarely mentioned) business of working out their own needs for connection and disconnection. When established as a central focus of supervision, however, the supervisory relationship can form the very crucible in which supervisees learn how to become therapeutic. This relational learning can empower both supervisee and supervisor.
References Collins, P. H. (2000). Black feminist thought (2nd ed.). New York: Routledge. Eldridge, N. S., Surrey, J. L., Rosen, W. P., & Miller, J. B. (2003). What changes in therapy? Who changes? Work in Progress, No. 99. Wellesley, MA: Wellesley Centers for Women. Hubble, A. M., Duncan, B. L., & Miller, S. D.(1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association. Jordan, J. V. (2002). A relational-cultural perspective in therapy. In F. Caslow (Ed.), Comprehensive handbook of psychotherapy (Vol. 3, pp. 233-254). New York: Wiley. Jordan, J. V. (2004) Relational learning in psychotherapy consultation and supervision. In M. Walker & W. B. Rosen (Eds.), How connections heal. New York: Guilford. Miller, J. B. (1988). Connections, disconnections, and violations. Work in Progress, No. 33. Wellesley, MA: Wellesley Centers for Women. Miller, J. B. (2002). How change happens: Controlling images, mutuality, and power. Work in Progress, No. 96. Wellesley, MA: Wellesley Centers for Women. Miller, J. B., Jordan, J. V., Stiver, I. P., Walker, M., Surrey, J. L., & Eldridge, N. S. (2004). Therapist’s authenticity. In J. V. Jordan, M. Walker, & L. M. Hartling (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute. New York: Guilford. Miller, J. B., & Stiver, I. P. (1991). A relational reframing of therapy. Work in Progress, No. 52. Wellesley, MA: Wellesley Centers for Women. Miller, J. B., & Stiver, I.P. (1994). Movement in therapy: Honoring the “strategies of disconnection”. Work in Progress, No. 65. Wellesley, MA: Wellesley Centers for Women. Miller, J. B., & Stiver, I. P. (1995). Relational images and their meanings in psychotherapy. Work in Progress, No. 74. Wellesley, MA: Wellesley Centers for Women. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford. Walker, M. (2004). How relationships heal. In M. Walker & W. B. Rosen (Eds.), How connections heal. New York: Guilford. Walker, M., & Miller, J. B. (2000). Racial images and relational possibilities. Talking Paper, No. 2. Wellesley, MA: Wellesley Centers for Women. Yalom, I. D., & Elkin, G. (1990). Every day gets a little closer: A twice-told therapy. New York: Basic. 27
Texas Psychologist
Psychologists, the Homeless, and HIV David Weigle, PhD, MPH Austin, Texas
The information in the following article is provided by the author(s), with consensus of the Social Justice Task Force, to facilitate analysis and discussion of the issues presented. It is not intended to represent official policy of the Texas Psychological Association or the opinions of its membership. It is recognized that there are many differences among our perspectives, and comments are invited.
T
he homeless population in Texas and across the United States is generally not a demographically stable group; rather it shows a diverse range of characteristics as people cycle in and out of homelessness. Important subgroups among the homeless include homeless single adults, homeless families, and homeless adolescents, and while these subgroups show distinct patterns of homelessness, the unifying thread in what Levy and O’Connell (2004) have referred to as the tapestry of homelessness is persistent and abject poverty. 28
Resource deprivation and the necessity of living life in a survival mode contribute to the poor health status that is typical for homeless people. On average, homeless adults have eight to nine concurrent medical illnesses (Breakey, Fischer, Kramer, Nestadt, Romanoski, Ross, Royall, & Stine, 1989), and the prevalence of mental disorders among the homeless ranges from 80-95% (Martens, 2001). As a group they have high morbidity and mortality (Hwang, 2000), underutilize ambulatory medical services (Kushel, Vittinghoff, & Haas, 2001), and overutilize
inpatient (Gallagher, Anderson, Koegel, & Gelberg, 1997) and emergency department services relative to the general population. Unfortunately, the homeless constitute a population that is among the most vulnerable to HIV transmission and AIDS. The homeless have a significantly, and sometimes dramatically, higher HIV infection rate than the general population (D’Amore, Hung, Chiang, & Goldfrank, 2001; Robertson, Clark, Charblebois, Tulsky, Long, Bangsberg, & Moss, 2004; Smereck & Hockman, 1998), and, although HIV is no respecter of skin color, homeless Hispanic males and African American females seem to be at particularly high risk. Furthermore, Rahva, Nuttbrock, Rivera, and Link (1998) found that prolonged homelessness is the condition most strongly associated with risky sexual conduct that often leads to viral transmission. A number of barriers to care for HIV+ homeless people have been identified. These include access to care, lack of health insurance, insufficient documentation/entitlements, inadequate transportation, stigmatization, racial and ethnic background, history SPRING 2006
Texas Psychologist 8, 1051-1055.
of incarceration, and underfunded and fragmented services (Douaihy, Stowell, Bui, Daley & Salloum, 2005). When these barriers can be adequately addressed, Highly Active Anti-Retroviral Therapy (HAART) has proven to be a very successful medical intervention in the battle against HIV and AIDS. However, physicians have been shown to be hesitant to prescribe these drug regimens to homeless people with HIV (Loughlin, Metsch, Gardner, Anderson-Mahoney, Barrigan, & Strathdee, 2004; Maisels, Steinberg, & Tobias, 2001) because of the stringent adherence standards that are required for the medication to be effective and not cause further harm. A recent study, however, found that well over half of homeless or marginally housed HIV+ drug users reported perfect adherence levels (Waldrop-Valverde & Valverde, 2005). This suggests that when evaluating patient readiness for HAART, current housing status may not need to be a primary concern. Rather, issues that psychologists and other mental health professionals are well-prepared to address may provide opportunities for meaningful interventions for homeless HIV+ persons. For example, the effectiveness of HIV prevention interventions can be strengthened by using ‘process of change’ constructs as a basis for service delivery (Milstein, Lockaby, Fogarty, Cohen, & Cotton, 1998). Indeed, coordinated treatment programs for homeless adults usually result in better health outcomes than does standard care (Hwang, Tolomiczenko, Kouyoumdjian, & Garner, 2005). The American Psychological Association’s HIV Office for Psychology Education has identified twelve common roles that psychologists can appropriately fill to intervene positively with HIV+ populations (American Psychological Association, 2006). These include: 1. Assist with Patient Empowerment 2. Assist with Identifying and Articulating Expectations of Health Care Team 3. Assist Patient in Building Relationships with the Health Care Team 4. Facilitate Communication with Health SPRING 2006
Care Providers 5. Explore Patients’ Understanding of Medical Conditions and Treatments 6. Work with patients to be better observers and communicators of symptoms and side effects so they can better assist the physician 7. Explore Patient’s Personal Meanings of Illness, Symptoms & Treatments 8. Prepare patients for difficult medical procedures 9. Assist patient and treatment team in communicating with family about medical condition, treatments and their role in process. (How they can help) 10. Help patients cope with side effects of treatment 11. Assist Patients with Adherence to Medication Regimens 12. Assist Patients with Emotional Reactions to Medical Decision-Making Each of these roles is adaptable for use with people who are homeless. There is no doubt that HIV/AIDS constitutes a complex and difficult epidemic that is affecting the most vulnerable people in our society. The good news is that we know how to intervene in ways that make a difference. The not-so-good news is that we find it easy to overlook those who need our help the most. Isn’t it time that we respond to the needs of those living in the shadows of our own backyards?
References American Psychological Association. (2006). The HOPE Training Program Resource Package, 2006. Washington, DC: American Psychological Association Breakey, W. R., Fischer, P. J., Kramer, M., Nestadt, G., Romanoski, A. J., Ross, A., Royall, R. M., & Stine. (1989). Health and mental health problems of homeless men and women. Journal of the American Medical Association, 262, 1352-1357. D’Amore, J., Hung, O., Chiang, W., and Goldfrank, L. (2001). The epidemiology of the homeless population and its impact on an urban emergency department. Academic Emergency Medicine,
Douaihy, A. B., Stowell, K. R., Bui, T., Daley, D., and Salloum, I. (2005). HIV/AIDS and homelessness, part 1: Background and barriers to care. The AIDS Reader, Oct 1, 2005, 516. Gallagher, T. C., Anderson, R. M., Koegel, P., and Gelberg, L. (1997). Determinants of regular source of care among homeless adults in Los Angeles. Medical Care, 35, 814-830. Hwang, S. (2000). Mortality among men using homeless shelters in Toronto, Ontario. Journal of the American Medical Association, 283, 21522157. Hwang, S., Tolomiczenko, G., Kouyoumdjian, F. G., and Garner, R. E. (2005). Interventions to improve the health of the homeless: A systematic review. American Journal of Preventive Medicine, 29, 311-319. Kushel, M. B., Vittinghoff, E., and Haas, J. S. (2001). Factors associated with the healthcare utilization of homeless persons. Journal of the American Medical Association, 285, 200-206. Levy, B. D. and O’Connell, J. J. (2004). Health Care for Homeless Persons. New England Journal of Medicine, 350, 2329-2332. Loughlin, A., Metsch, L., Gardner, L., Anderson-Mahoney, P., Barrigan, M., and Strathdee, S. (2004). Provider barriers to prescribing HAART to medically-eligible HIV-infected drug users. AIDS Care, 16, 485-500. Maisels, L., Steinberg, J., and Tobias, C. (2001). An investigation of why eligible patients do not receive HAART. AIDS Patient Care and STDs, 15, 185-191. Martens, W. H. (2001). A review of physical and mental health in homeless persons. Public Health Reviews, 29, 13-33. Milstein, B., Lockaby, T., Fogarty, L., Cohen, A., and Cotton, D. (1998). Processes of change in the adaptation of consistent condom use. Journal of Health Psychology, 3, 349-368. Rahva, M., Nuttbrock, L., Rivera, J. J., and Link, B. G. (1998). HIV infection risks among homeless, mentally ill, chemically misusing men. Substance Use and Misuse, 33, 1407-1426. Robertson, M. J., Clark, R. A., Charblebois, E. D., Tulsky, J., Long, H. L., Bangsberg, D. R.., and Moss, A. R. (2004). HIV seroprevalence among homeless and marginally housed adults in San Francisco. American Journal of Public Health, 94, 1207-1217. Waldrop-Valverde, D. and Valverde, E. (2005). Homelessness and psychological distress as contributors to antiretroviral nonadherence in HIVpositive injecting drug users. AIDS Patient Care and STDs, 19, 326-334.
29
Student Merit Research Awards The Student Merit Research Competition is open to undergraduate and graduate psychology students throughout Texas and is intended to promote student research. Students who were enrolled at some point in a Texas college or university during the Academic Year 2005-2006 are eligible. There are four categories for completed student research, including: a) $1500 for the Roy Scrivner Gay/Lesbian/Bisexual Issues Research Award b) $1500 for the Bo and Sally Family Psychology Research Award c) $500 for the Alexander Psychobiology/Psychophysiology Award d) $500 for the Manuel Ramirez Dissertation Award for research related to ethnic minority psychology.
Eligibility Submissions must be made by undergraduate or graduate Texas psychology students, enrolled at some time during the 2005-200 academic year, and may include students who are on currently on internship. The student submitting the manuscript must be the first author on the research manuscript.
Instructions for Submission The research manuscript should be written in APA format and be no longer than 20 typed, double-spaced pages including tables, figures, and references. A letter from the student’s faculty sponsor is also required and should address the degree to which the candidate had responsibility for the project objectives, design, data collection, data analysis, and manuscript preparation; this letter should also include a brief statement identifying when the student was enrolled during the 2005-2006 academic year. In addition, the submission must include a demographic sheet clearly indicating the name of the individual submitting the manuscript, her or his address, phone numbers, and e-mail address, and the university affiliation of the student and sponsoring faculty member. Submissions will be accepted immediately, but must be received no later than August 15, 2006. Four copies of the paper, and one copy of the demographic sheet and letter from the faculty sponsor should be mailed in an envelope together to: TPF - Awards 1005 Congress Avenue, Ste. 410 Austin, TX 78701 Submissions will be rated on methodological rigor, clarity of writing, and contribution to the literature. The winner from each of the categories will attend The Awards Luncheon at the 2006 TPA Annual Convention in Dallas.
The Student Research Proposal Awards The Student Research Proposal Awards are open to undergraduate and graduate psychology students throughout Texas and are intended to provide funding for faculty-supervised research projects. Full-time students who will be enrolled in a Texas college or university during the Academic Year 2005-2006 are eligible. The research should be completed and results submitted in manuscript form to the Texas Psychological Foundation within two years. The Undergraduate Proposal Award is designed to provide funding for an undergraduate’s research proposal related to the broad area of Community/Public Service. This award will be for $500. The Graduate Proposal Award is designed to provide funding for a graduate student’s research proposal related to the broad area of psychotherapy. This award will be for $1000. Interested students should provide four copies of a research proposal, including faculty sponsor, literature review, research design, and budget, of no more than 10 pages, to be received by August 15, 2006, to: Texas Psychological Assn Awards 1005 Congress Avenue, Ste. 410 Austin, TX 78701 30
SPRING 2006
TPA Distinguished Professional Contribution Awards Each year at the TPA’s Annual Convention, awards are presented to psychologists and other individuals who have made significant contributions to professional psychology. Nominations are currently being accepted for awards in the following areas: * Outstanding Contribution to Education * Outstanding Contribution to Science * Outstanding Contribution to Public Service * Psychologist of the Year (Silver PSI Award) * Distinguished Lifetime Achievement * Outstanding Media Coverage * Outstanding Legislative Contribution * Outstanding Public Contribution to Psychology * Student Merit Research Award (separate application process; see page 30) Nominations are reviewed by the TPA Awards Committee. The Committee’s recommendations will be submitted to the TPA Board of Trustees for final approval. A description of each award category, the criteria for the nominees, and the nomination form are included below. All 2006 awards nominations must be received by August 15, 2006. Awards will be presented during the TPA Awards Luncheon at the TPA Annual Convention in Dallas, which will be held November 16-18, 2006 at the Westin - Galleria. If you or your organization would like to nominate someone, including yourself, please complete the nomination materials and return them by the August 15, 2006 deadline to: Texas Psychological Assn Awards 1005 Congress Avenue, Ste. 410 Austin, TX 78701 admin@texaspsyc.org It is important to note that all nominators are responsible for completing and sending the required nomination materials by the August 15, 2006 deadline. This includes: * an up-to-date copy of the nominee’s professional vita; * nomination form; * endorsements from other individuals or groups, if desired. Nominators are invited to be present and introduce the winners at the awards presentation at the 2006 Annual Convention.
GUIDELINES FOR SUBMITTING NOMINATIONS 1) Nominations must be received by August 15, 2006. 2) Complete application form and attach up-to-date vita for nominee. 3) Email to (email is the preferred contact method): admin@texaspsyc.org Or mail 5 copies to: Texas Psychological Assn Awards 1005 Congress Avenue, Ste. 410 Austin, TX 78701
GENERAL CRITERIA FOR NOMINEES (For nominees inside the field of psychology) 1. Active engagement at the time of nomination in the advancement of psychology in any of its aspects. 2. Five years of acceptable professional experience subsequent to the granting of the graduate degree in psychology. 3. Evidence of unusual and outstanding contribution or performance in the field of psychology. 4. Influence on the profession outside one’s setting. 5. Evidence or documentation that the nominee has enriched or advanced the field on a scale beyond that of being a good practitioner, teacher, researcher or supervisor. 6. Texas Psychological Association Member in good standing. SPRING 2006
31
AWARD DESCRIPTIONS OUTSTANDING CONTRIBUTION TO EDUCATION Description: This award recognizes a truly distinguished contribution to psychology in the area of education. Outstanding contributions
might be in the areas of teaching, design of teaching methodologies, curriculum, or behavior managerial techniques; psychological research specific to the area of education, leadership in educational development, reform and design of training programs, or successful grant awards and projects that benefit education. Specific Nominee Criteria: Nominees for the Outstanding Contribution to Education award must hold a master’s or doctoral degree in psychology and/or be a licensed psychology professional as well as a current member of TPA.
OUTSTANDING CONTRIBUTION TO SCIENCE Description: This award recognizes a significant scientific contribution in the discovery and development of new information, empirical
or otherwise, to the body of psychological knowledge. Contributions might include new theories or integration of existing theories of knowledge in ways that enhance understanding, prediction or control of human behavior. It might also include research that develops procedures, methodologies or technical skills that improve ability to provide direct, practical or more immediate solutions to psychological problems. Specific Nominee Criteria: Nominees for the Outstanding Contribution to Science Award should be easily identified as working within the field of psychology, should hold a graduate degree in psychology and/or be a licensed psychology professional as well as a current member of TPA.
OUTSTANDING CONTRIBUTION TO PUBLIC SERVICE Description: This award recognizes psychology practitioners who have made outstanding contributions that can be identified as direct and
on the behalf of the public. These contributions might have resulted in a significant benefit to the general public or might have made a major contribution to a special population. This award may also be bestowed on psychology practitioners who have distinguished themselves through activities that are legislative, legal, political, or organizational, that have resulted in direct benefits to the public. Specific Nominee Criteria: Nominees for the Outstanding Public Service Award should be easily identifiable in their capacity as a public servant, hold a graduate degree in psychology and be working within the field, and/or be a licensed professional within the state as well as a current member of TPA.
PSYCHOLOGIST OF THE YEAR Description: This award is given annually (Silver PSI) to a psychologist who is recognized as having made one of the most significant and
recent impacts on the field of psychology within the state of Texas. The award may be given for overall service and enhancement of the profession, but if it is given for a specific activity or event, the event should have occurred within 36 months previous to the nomination. The award might be given for any of the psychological or scientific contributions recognized by other awards. It might be awarded for a particularly notable book, research publication, legislative activity or public performance. Specific Nominee Criteria: The individual selected for this award must hold a doctoral degree in psychology and be a licensed psychologist as well as a current member of TPA.
DISTINGUISHED LIFETIME ACHIEVEMENT Description: This award is generally given to a psychologist who is nearing the end of his or her career as a psychologist and who has a
long and distinguished record of exemplary professional service. The person receiving this award should be recognized as esteemed by other psychologists as well as by a wide range of professionals in other areas. Accomplishments should be of a caliber that would be recognized as outstanding at a national as well as a state level. Specific Nominee Criteria: The individual selected for this award must hold a doctoral degree in psychology and be a licensed psychologist as well as a current member of TPA.
32
SPRING 2006
OUTSTANDING MEDIA COVERAGE Description: This award is presented by the Texas Psychological Association to an individual or organization that has benefited the profes-
sion of psychology through a media event. The award might be awarded to a journalist because of a newspaper article or a series of articles that enhances the public knowledge concerning the profession of psychology or expands knowledge or awareness about a psychological disorder. The award might be given to a television broadcaster, news anchorperson, radio personality or producer of a film or video. Specific nominee criteria: Although psychologists are not excluded from this award category, it is generally considered to be an award bestowed to someone external to the profession of psychology.
OUTSTANDING LEGISLATIVE CONTRIBUTION Description: This award is given to a legislator, legislative employee or other individual who has had a major role in initiating advocacy in favor of or passing legislation that has a major impact on the practice of psychology in Texas. This legislation might improve practice regulations, increase employment opportunities, or more clearly define the practice standards. It might provide easier access to psychological services or expand the professional roles of psychologists. Specific Nominee Criteria: Although psychologists are not excluded from receiving his award, it is generally bestowed on an individual external to the profession of psychology.
OUTSTANDING PUBLIC CONTRIBUTION TO PSYCHOLOGY Description: This award is given to a member of the public who has made a significant contribution to the field of psychology. This con-
tribution might be through financial support, dissemination of information, research contributions, media exposure or a wide range of other possibilities. Nominee Criteria: This award must be given to an individual outside the field of psychology.
TPA AWARDS NOMINATION FORM Name of Award: ________________________________________________________________________________
Nominee: Name: ________________________________________________________________________________ Address: ______________________________________________________________________________ E-mail: ____________________________________ Phone: _____________________________________
Nominator: Name: ________________________________________________________________________________ Address: ______________________________________________________________________________ E-mail: ____________________________________ Phone: _____________________________________ Please list reasons why this nominee should receive the TPA award named above: (refer to the description of the award for relevant criteria) 1.____________________________________________________________________________________ 2.____________________________________________________________________________________ 3.____________________________________________________________________________________
SPRING 2006
33
Texas Psychologist
PSYPAC CONTRIBUTORS Sylvia Gearing Patricia D. Weger B. Thomas Gray Bexar County Psychological Assn Thomas Johnson Verlis Setne Michael Bridgewater Kim Arredondo Patricia Barth Kay Campbell S. Jean Ehrenberg Emily Fallis Martin Gieda Paul Hamilton Willam J. Holden Bruce Kruger Rose McDonald James McLaughlin George R. Mount Gary Neal Cynthia Pladziewicz John Price Ken Waldman Constance Adler Mary Alvarez-del-Pino Lisa Balick Constance Byers Maria Concepcion Cruz Mark Cunningham Daniel Diaz James Duncan Pamela Grossman Melinda J. Longtain Bruce Mansbridge Stephen K. Martin Donald C. McCann Marsha D. McCary Will Norsworthy Randy E. Phelps
Dana Turnbull Nancy Wilson William Frazier Freddy A. Paniagua Dean Paret Paul Andrews Larry Aniol Kyle Babick Joan Berger James Berkshire Peggy Bradley Ray Brown Timothy Brown Joan Bruchas Sam Buser L. Carol Butler Ron Cohorn Sean Connolly Mary Alice Conroy Mary Cox James Crawford Sally Davis Marie-Elise DuBuisson Richard Eckert Anette Edens Wayne Ehrisman Patrick Ellis Donald Ennis Alan Fisher Cynthia Galt Elizabeth Garrison Karen Gollaher Jerry Grammer Dennis Grill Michael Hand Lillie Haynes David Hopkinson Sandra Hotz Daniel W. Jackson Charlotte Jensen
Rita Justice Burton A. Kittay Joseph Kobos John W. Largen Victor Loos Alaire Lowry Thomas Lowry Ann Matt Maddrey Janna Magee Stephen McCary Jill McGavin Richard M. McGraw Sherry McKinney Robert J. McLaughlin Robert Mehl Robert S. Meier Daneen Milam Maritza Milan Janel H. Miller Fernando Obledo Sherry L. Payne Robert Rankin Robin Reamer Herbert Reynolds David M. Sabine Gordon C. Sauer, Jr. W. Truett Smith Deborah J. Voorhees Ann P. Vreeland Laurel Wagner Michael Walker Connie S. Wilson James R. Womack John W. Worsham Robert Zachary Cheryl Hall Judith Andrews Julie Bates Thomas Van Hoose Edward Davidson
LEGISLATIVE CHAMPIONS William Frazier Richard Fulbright Dorothy C. Pettigrew Larry Aniol Connie Benfield Joan Berger James Berkshire Constance Byers Sean Connolly Mary Cox Anette Edens Burton A. Kittay Marcia Laviage Sherry McKinney Ann Salo James R.Womack Constance D. Wood
2006 TPF CONTRIBUTORS B. Thomas Gray Mary De Ferreire Jerry Grammer Victor Loos Ann P. Vreeland Nicolas Carrasco
CLASSIFIED ADVERTISING
34
TARNOW CENTER
BAYLOR COLLEGE OF MEDICINE.
Expanding interdisciplinary private group practice seeks a Texas licensed Psychologist, must have experience in working with children school age to adolescents. Located in a prominent part of Houston, the office has a very attractive setting. Very little managed care/emergency work. Forward resumes by fax: 713621-7015 or email john@tarnowcenter.com.
Assistant Professor. Provide: projective and objective testing, EMDR, CBT and dynamic treatments to adults, adolescents. Teaching and supervision of trainees and junior staff; coordinate, assess and make recommendations to licensing boards. Requirement: doctorate in clinical psychology, plus 2 years of postdoctoral training in clinical psychology treating professionals in crisis. Texas Licensed or license eligible. Fax resume to 713-7985522 Attn.: Michele Stelljes, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030. BCM is an EO,AA, EA Employer.
SPRING 2006
Psychologists Needed
IMMEDIATELY
TPA
CAREER CENTER Finding the perfect job has never been easier.
P P P P
POST YOUR RESUME TODAY ACCESS PREMIER JOB POSTINGS RECEIVE JOBS VIA EMAIL LAND THE PERFECT JOB
www.texaspsyc.org
TPA Homestudy Opportunities Earn Continuing Education in the comfort of your home or ofďŹ ce! Simply download the articles or read online, then complete the exam and send back with appropriate fee. Download articles at www.texaspsyc.org Applied Ethics and Law for Texas Psychologists (3 hours ethics CE) Professional Ethics for School Psychology (3 hours ethics CE) Therapeutic Contract (1 hour ethics CE) A Practical Guide to Risk Assessment (1 hour ethics CE) Substance Use Disorders (2 hours CE) more coming soon
Save the dates for these Texas Psychological Association
Continuing Education Events
2007 Annual Convention
2006 Annual Convention November 16-18, 2006
November 15-17, 2007
Dallas, Texas
San Antonio, Texas
Westin Galleria
Westin La Cantera Resort
13340 Dallas Parkway
16641 La Cantera Pkwy
(discounted rate of $129 for reservations made before 10/27/06)
3 full days of continuing education credit available
Additional information coming to www.texaspsyc.org soon!
PRESORTED STANDARD U.S. POSTAGE PAID AUSTIN, TX PERMIT #1149